Open Reduction and

Internal Fixation
(ORIF)
DESCRIPTION

Open Reduction and Internal Fixation (ORIF)

Open reduction and internal fixation (ORIF) is Open reduction internal fixation (ORIF) is usually
surgery to repair a broken bone. completed in two stages.
Open reduction means the doctor makes an First, the broken bone is reduced, specifically, a reduction
incision (cut) to reach the bones and move them by manipulation of the bone after surgical exposure at the
back into their normal position. site of the fracture.
Internal fixation means metal screws, plates, Second, an internal fixation device is placed on or in the
sutures, or rods are placed on the bone to keep it bone. Internal fixation devices for this type of procedure
in place while it heals. The internal fixation will can include screws, plates, rods and pins to hold the
not be removed. segments of the broken bones together.

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INDICATIONS

Open Reduction and Internal Fixation (ORIF)

This surgery is done on an arm or a leg to repair Surgeons may recommend ORIF if:
fractures that would not heal properly with a cast The bone is broken into many pieces
or splint alone.
▰ The bone is sticking out of the skin
▰ The bone is not lined up correctly
▰ A closed reduction (without opening the skin) was
done before and it didn’t heal properly
▰ A joint is dislocated

This surgery should allow the bone to heal properly. When

it does, patient will experience less pain and be better able
to move and use the arm or leg.

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 POTENTIAL BENEFITS, RISKS, COMPLICATIONS,
AND ALTERNATIVES

Potential Benefits Risks & Potential Complications Alternatives

ORIF surgery may: ▰ Risks associated with any surgery: Bleeding that ORIF is usually done only when the
would require a blood transfusion; infection; allergic break is so severe that it is the
▰ Decrease pain and help reaction to anesthesia only option.
your broken arm or leg heal ▰ Risks associated with ORIF:
correctly. ▻ Nerve damage that reduces feeling in the If the break is not severe, your
▰ Restore the bone to its arm or leg doctor may be able to move the
normal function. ▻ Hardware in the arm or leg moving out of bones back into place, or maintain
▰ Prevent further injury. place the position of the bones with a
▻ Pain, swelling, or trouble moving the arm or cast or a brace while it heals.
leg
▻ Incomplete healing of the bone
▻ Increased pressure in the arm or leg
(compartment syndrome) which can damage
muscles and tissue
▻ Blood clot, possibly traveling to the heart
(pulmonary embolism)
▻ Muscle spasms 4
 HOW IS IT DONE?

Since broken bones are usually caused by an accident, ORIF is usually an emergency surgery. How long the surgery lasts depends on how
severe the break is. In many cases, the surgery lasts a few hours. Here’s what happens:

▰ Anesthesia: An anesthesia provider will discuss ▰ Closing the incision: Your incision will be closed
your pain control with you. You will likely be given with stitches or staples and covered with a
general anesthesia so you sleep through the bandage. A cast or splint will be put on to protect
procedure and don’t feel anything. You may also be the repair as it heals.
given a nerve block to decrease pain after surgery. ▰ Recovery: After the surgery, you will be taken to a
▰ Incision: The surgeon will make an incision (cut) in recovery area to be monitored until you are awake
the skin over the bone. and doing well. Your circulation, sensation, and
▰ Moving the bone into place: The surgeon will movement will be checked often. Most patients
move the bone into the correct position. Metal with an arm fracture go home the day of surgery.
plates, rods, sutures, and/or screws will then be Patients with a leg fracture sometimes stay longer.
applied to hold the bone together as it heals. An
x-ray may be taken after the devices are attached.

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WHAT TO EXPECT:

Complete recovery usually takes 3 to 12 months. How long it takes depends on how severe the fracture was, and
whether nerves and blood vessels were damaged. The doctor may recommend physical therapy during the
recovery. A physical therapist can teach the exercises to help in regaining strength and motion in the limb. These
exercises may be necessary for the patient to be able to use his/her arm or leg the way he/she used to.

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 PRE-OPERATIVE PREPARATION

PREPARATION OF THE PATIENT

History & Physical Examination:

The surgeon and team should obtain a proper history from The history of present illness is not necessarily confined to the patient
each patient. The history of present illness includes details interview. Family members or guardians provide useful information, and
about the presenting condition, including establishing the outside records can be indispensable.
acuity, urgency, or chronic nature of the problem. One must secure a list of active medications, with dosages and schedule.
The surgeon should request CD-ROM disks of outside Medication allergies and adverse reactions should be elicited, although
imaging, if appropriate. knowledge about environmental and food allergies is also valuable and
should be recorded so that these exposures are avoided during the hospital
The past medical history should include prior operations, stay.
especially when germane to the current situation, medical
conditions, prior venous thromboembolism (VTE) events such
as deep vein thromboses (DVT) or pulmonary emboli (PE),
bleeding diatheses, prolonged bleeding with prior operations
or modest injuries (eg, epistaxis, gingival bleeding, or
ecchymoses), and untoward events during surgery or
anesthesia, including airway problems. 7
 PRE-OPERATIVE NURSING PREPARATION

▰ Basic orthopaedics instrument ▰ Environment

▰ Nerve repair set ▻ Radiolucent operation table
▰ Micro-vascular instrument ▻ X-ray technician % machine
▰ Microscope?Loupes ▻ Plaster technician
▰ Pulsatile lavage system ▰ Fixation Instruments confirmed with surgeon)
▰ 3000 cc saline ▰ Power instruments
▰ Suction bottles ▰ Bone graft instruments
▰ Buckets ▰ Skin graft instrument
▰ Free flap surgery instrument
▰ Microscope
▰ Gentamycin beads

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 PRE-OPERATIVE NURSING CONSIDERATIONS

▰ Theatre arrange/set-up ▰ Anaesthetic Preparations

▻ Availability of theatre ▻ Anaesthetic machine
▻ Size of theatre ▻ Arterial line, central line, CVP, IV lines
▻ Operation table ▻ Rapid infusion pump
▻ Availability of equipments % instruments ▻ Mass transfusion trolley
▻ Manpower ▻ Crash cart
▰ Procedure preparation ▻ Optical fiber- Flexible Bronchoscope
▻ Neuro procedure ▻ Cell save machine
▻ Abdominal procedure ▻ Blood warmer
▻ Chest procedure ▻ Warming blanket
▻ Orthopaedic procedure
▰ Anaesthetic implications
▻ Treat life threatening conditions
▻ Prevent hypovolemic % hypothermia
▻ Maintain basic life requirement

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 PRE-OPERATIVE NURSING RESPONSIBILITIES

▰ Verify the doctor’s orders. ▰ Assess the patient for pain and administer pain medication, as
▰ Confirm the patient’s identity using at least two prescribed, using safe medication administration practices.
patient identifiers according to your facility’s Perform a follow-up pain assessment and notify the doctor if
policy. pain isn’t adequately controlled.
▰ Reinforce the doctor’s explanation of the ▰ Tell the patient what to expect during postoperative
procedure, and answer the patient’s questions. assessment and monitoring.
Ensure that the patient has signed a consent ▰ Teach the patient how to cough, deep breathe, and use an
form, according to your facility’s policy. incentive spirometer to reduce the risk of postprocedure
▰ Perform a comprehensive pain assessment using pneumonia.
techniques appropriate for the patient’s age, ▰ Prepare the patient for proposed exercise and progressive
condition, and ability to understand. ambulation regimens, if necessary.
▰ Plan for discharge and any projected changes in lifestyle due to
the surgery.

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 INTRA-OPERATIVE NURSING RESPONSIBILITIES

▰ Maintain patient safety. ▰ Provide emotional support to the patient and assisting the
▰ Continuous patient care. anesthesiologist during the initiation of anesthesia.
▰ Continuous assessment of the patient's physiologic ▰ Maintain sterile technique while providing supplies and equipment
and psychologic status. for the sterile team
▰ Prevent wound infection and promoting healing. ▰ Document all nursing care during the intraoperative period and
▰ Documentation making sure that surgical specimens are labeled correctly and
▰ Communication placed in the appropriate media
▻ Multidisciplinary team approach ▰ Recognize and resolve environmental hazards that involve the
▻ Surgeon changes plan patient or surgical team, including protecting the patient from
▰ Arrangement of manpower. electrical hazards
▰ Coordinate patient care before, during, and after the ▰ Ensure with the scrub tech that all sponge, instrument, and sharps
surgical procedure. counts are completed and documented

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 POST-OPERATIVE NURSING RESPONSIBILITIES

▰ Environment control ▰ Ensure adequate nutrition.

▻ Regulate temperature (26-28°C) ▰ Prevent skin breakdown and pressure sores:
▰ Hourly monitoring of flap parameters. ▻ Turn the patient frequently
(Peripheral limb circulation chart). ▻ Keep urine and faeces off skin Encourage early
▰ Maintaining adequate body system functions. mobilization:
▰ Restoring body homeostasis. ▻ Deep breathing and coughing
▰ Pain and discomfort alleviation. ▻ Active daily exercise
▰ Preventing postoperative complications. ▻ Joint range of motion
▰ Promoting adequate discharge planning and ▻ Muscular strengthening
health teaching. ▻ Make walking aids such as canes, crutches and
▰ Avoid any pressure on the flap walkers available and provide instructions for their
▰ Elevate the operated limb. use

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 SPECIFIC CARE IN PACU

▰ Maintain an optimal environment. ▰ Hourly monitoring of the flap/digit parameters using

▰ Quiet and warm area )Temperature the Peripheral limb circulation chart.
round 26-28°C) ▰ Obtain the first parameters reading by both the
▰ Monitor the room temperature. chief surgeon and PACU nurse. (Take it as valid
▰ Tips in setting up the warm area: baseline)
▻ Inform the PACU nurse once there ▰ During discharge, perform circulation monitoring
is a micro-vascular surgery. together with the ward nurse. (Minimize
▻ Using the clips to seal up the gap discrepancy)
between the two plastic curtains

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