Having Arm Fracture Open Reduction and Internal Fixation (ORIF)

Open reduction and internal fixation (ORIF) is a type of treatment to fix a broken bone. It puts the pieces of a broken bone back together so they can heal. Open reduction means the bones are put back in place during surgery. Internal fixation means that special hardware is used to hold the bone pieces together. This helps the bone heal correctly. The procedure is done by an orthopedic surgeon. This is a with specialized training in treating bone, joint, and muscle problems.

What to tell your healthcare provider

Make sure you tell the healthcare provider about all medicines you take, including over-the-counter medicines, such as aspirin. Tell them about all vitamins, herbs, and other supplements you take. Also tell the provider the last time you had something to eat or drink. And tell your healthcare provider if you:

• Have had any recent changes in your health, such as an infection or fever

• Are sensitive or allergic to any medicines, latex, tape, or anesthesia (local and general)

• Are pregnant or think you may be pregnant

Tests before your surgery

Before your surgery, you may need imaging tests. These may include CT scan, ultrasound, X-rays, or MRI scan.

Getting ready for your surgery

ORIF sometimes takes place as emergency surgery after an accident or injury. You’ll have a physical exam. X-rays may be taken of your arm. You may also have other imaging tests. A healthcare provider will ask you questions. They will also check your heart and lungs.

In some cases, arm fracture ORIF is planned. You may need to stop taking some medicines before the procedure, such as blood thinners and aspirin. If you smoke, you may need to stop before your surgery. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking.

Also make sure to:

• Ask a family member or friend to take you home from the hospital. You cannot drive yourself.

• Plan some changes at home to help you recover. You may need help at home.

• Follow any directions you are given for not eating or drinking before surgery.

• Follow all other instructions from your healthcare provider.

• Talk with your healthcare provider about what you can expect after surgery.

You will be asked to sign consent forms that give your permission to do the procedure and receive anesthesia. Read the forms carefully. Ask questions if something is not clear.

On the day of surgery

Your surgeon will explain the details of your surgery. The preparation and surgery may take a couple of hours. In general, you can expect the following:

• You may have general anesthesia. This will allow you to comfortably sleep through the surgery. Or you may have local (regional) anesthesia to numb the surgical area and medicine to help you relax and sleep through the surgery.

• A healthcare provider watches your vital signs, such as your heart rate, oxygen levels, and blood pressure, during the surgery.

• After cleaning the skin, your surgeon makes a cut (incision) through the skin and muscles of your arm. Or with some fractures, the surgeon makes an incision on the top of the shoulder.

• Your surgeon puts the pieces of your broken bone back in place. This is the reduction.

• Next, your surgeon uses special screws, plates, wires, or pins to hold the bone pieces together. This is the fixation. It helps the bone heal correctly. For a fracture in the middle of your upper arm, a special metal nail may be put through the middle of the bone. It screws into the bone at both ends.

• The surgeon will make other repairs to the area as needed.

• The surgeon will close the layers of muscle and skin on your arm with stitches (sutures) or staples.

After your surgery

After surgery you will be taken to the postanesthesia care unit where your vital signs will be kept track of as you wake up from the anesthesia. You will be given pain medicine if needed. You may be able to go home the same day, or stay overnight in the hospital. Before leaving the hospital, you may have X-rays taken of your arm. This is to check the repair.

You might have some fluid draining from your incision. This is normal. You will have some pain after the surgery. Your healthcare provider will tell you what pain medicine you can take to help reduce the pain. Stay away from certain over-the-counter medicines for pain as instructed. Some of these may interfere with bone healing. You can also use ice packs to help reduce pain and swelling. To make an ice pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Never put ice or an ice pack directly on the skin. Use ice packs 3 to 4 times daily for 20 minutes at a time as instructed.

You may be told to not move your arm for a while after your surgery. You may need to wear a splint for several weeks. You will get instructions about when and how you can move your arm. Your surgeon may also tell you to eat foods high in calcium and vitamin D to help with bone healing.

Follow-up care

Keep all of your follow-up appointments. You may need to have your stitches or staples removed a week or so after your surgery.

You may have physical therapy to improve the strength and movement of your arm. The therapy may include treatments and exercises. The therapy improves your chances of a full recovery. Most people are able to return to their normal activities within a few months.

When to call your healthcare provider

Call your healthcare provider or get medical care right away if you have any of these:

• Fever of 100.4°F (38°C) or higher, or as directed by your provider

• Chills

• Redness, swelling, or fluid leaking from your incision that gets worse

• Pain that gets worse

• Loss of feeling in your arm or hand, coldness, or change in color