Arm Fracture Open Reduction and Internal Fixation
What is open reduction and internal fixation for an arm fracture?
Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize
and heal a broken bone. You might need this procedure to treat your broken arm.
The humerus is the bone in the upper part of your arm. Different kinds of injury can
damage this bone, usually from a direct blow to the arm from a fall or collision,
causing it to fracture into 2 or more pieces. This might happen in the part of the
humerus near your shoulder, near the middle of the humerus, or in the part of the
humerus near your elbow. In certain types of humerus fractures, your humerus is broken
but its pieces still line up correctly. In other types of fractures (displaced fractures),
the injury moves the bone fragments out of position.
If you fracture your humerus, you might need ORIF to bring your bones back into place
and help them heal. During an open reduction, orthopedic surgeons reposition the pieces
of your fractured bone surgically so that your bones are back in their correct position.
In a closed reduction, a doctor moves the bones back into place without surgically
exposing the bone.
Internal fixation refers to the method of reconnecting the bones. This method uses
special screws, plates, wires, or nails to align the bones correctly. This prevents
the bones from healing abnormally. The surgery usually takes place while you are asleep
under general anesthesia.
Why might I need an arm fracture open reduction and internal fixation?
Certain medical conditions may make fracturing you humerus more likely. For example,
osteoporosis increases the risk of arm fracture in many older adults.
Not everyone with a fractured humerus needs ORIF. In fact, most people don’t. If possible,
your doctor will treat your arm fracture with other treatments, like pain medicine,
splints, and slings.
You probably won’t need ORIF unless there is some reason your fracture might not heal
normally with these other treatments. You are likely to need ORIF if:
The pieces of your humerus are severely out of alignment
Your humerus broke through the skin
Your humerus broke into several pieces
In these cases, ORIF can align your bones back into the right position. This greatly
increases the chance that your bone will heal normally.
You might need ORIF for a fracture that occurs anywhere along your humerus, including
the portions near the shoulder and the elbow.
In some cases, your doctor might discuss other surgical options with you, like a shoulder
replacement if you have severe damage to the top of your humerus. Talk to your doctor
about the risks and benefits of all your options.
What are the risks of arm fracture open reduction and internal fixation?
Most people do very well after ORIF. But rare complications can sometimes occur. Possible
Screw perforation of the humeral head
Broken screws or plates
Tissue death due to low blood supply (avascular necrosis) in the humerus
Loss of range of motion
Bone out of position, or failure to heal
Complications from anesthesia
There is also the risk that the fracture won’t heal normally, and you’ll need a repeat
Your own risk of complications may vary according to your age, how and where your
humerus breaks, and your other health conditions. For example, people with low bone
mass or diabetes may be at higher risk of complications. Being a smoker may also increase
your risk. Ask your doctor about the risks that most apply to you.
How do I get ready for arm fracture open reduction and internal fixation?
ORIF often takes place as an urgent procedure. Before your procedure, a healthcare
provider will ask about your medical history and give you a physical exam. You’ll
have an image of your humerus taken, probably with an X-ray or MRI. Tell your doctor
about all the medicines you take, including over-the-counter medicines like aspirin.
Also, let your doctor know the last time you ate.
In some cases, your doctors might do your ORIF as a planned procedure. If this is
the case, you should talk to your doctor about how you can prepare. Ask if you should
stop taking any medicines ahead of time, like blood thinners. You’ll need to not eat
or drink after midnight the night before your procedure.
What happens during arm fracture open reduction and internal fixation?
Your doctor can help explain the details of your surgery. The details of your surgery
will depend on the location and severity of your injury. An orthopedic surgeon assisted
by a team of specialized healthcare providers will do the surgery. The surgery may
take a couple of hours. In general, you can expect the below:
You will receive general anesthesia, so that you’ll sleep through the operation and
won’t feel anything. (Or, you may receive local anesthesia and a medicine to help
A healthcare provider will carefully watch your vital signs, like your heart rate
and blood pressure. You may have a breathing tube inserted down your throat during
the surgery to help you breathe.
After cleaning the affected area, your surgeon will make an incision through the skin
and muscle of your arm. For certain types of injuries, your surgeon might make an
incision through the top of your shoulder instead.
Your surgeon will bring the pieces of your humerus back into position (reduction).
Next, your surgeon will secure the pieces of humerus to each other (fixation). To
do this, he or she may use screws, metal plates, wires, and pins. Ask what the surgeon
will use in your case.
Your doctor will make any other necessary repairs.
After the team has secured the bone, your doctor will surgically close the layers
of skin and muscle around your arm.
What happens after arm fracture open reduction and internal fixation?
Talk to your doctor about what you can expect after your surgery. You may have a lot
of pain after your procedure, but pain medicine may help to reduce the pain. You should
be able to resume a normal diet fairly quickly. You will probably have imaging done,
like an X-ray, to make sure that the surgery was successful. Depending on the extent
of your injury and your other medical conditions, you might be able to go home the
For a while after your surgery, you’ll need to keep the arm immobile. Often, this
means you need to wear a splint or sling for several weeks. Make sure to protect your
splint from water. You’ll receive instructions about how you can move your arm.
Your doctor might give you other instructions about caring for your arm, like applying
ice. Follow all your doctor’s instructions carefully. Your doctor might not want you
to take certain over-the-counter medicines for pain, because some of these can interfere
with bone healing. Your doctor may advise you to eat a diet high in calcium and vitamin
D as your bone heals.
You might have some fluid draining from your incision. This is normal. Let your doctor
know right away if:
You see an increase in redness, swelling, or draining from your incision
You have a high fever or chills
You have severe pain in your arm
You have loss of feeling in the arm or hand
Make sure to keep all of your follow-up appointments. You may need to have your stitches
or staples removed a week or so after your surgery.
At some point, you may need some sort of physical therapy to restore strength and
flexibility to your muscles. Doing your exercises as prescribed can improve your chances
of a full recovery. Most people are able to return to all their normal activities
within a few months.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure