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Open Reduction Internal Fixation (ORIF) / Plate and Screws

Medical term: Open Reduction Internal Fixation

Recovery: 6-12 weeks

Overview

Open reduction internal fixation, commonly known as ORIF, is one of the most frequently performed procedures in orthopedic trauma surgery. It involves surgically exposing a fracture, restoring the bone fragments to their normal alignment, and securing them with metal implants such as plates and screws. ORIF is used when a fracture is displaced, unstable, or involves a joint surface and cannot be adequately treated with casting alone.

At our San Diego practice, our fellowship-trained orthopedic trauma surgeons perform ORIF for fractures throughout the body, including the wrist, ankle, shoulder, elbow, hip, and lower extremity. We use the latest implant systems and techniques to achieve precise fracture reduction and stable fixation, giving our patients the best foundation for healing and functional recovery.

  • Displaced fractures — bone fragments have shifted out of alignment and cannot be adequately repositioned without surgery
  • Unstable fractures — the fracture pattern is such that the bone is unlikely to stay aligned in a cast
  • Intra-articular fractures — fractures that extend into a joint surface require anatomic restoration to reduce the risk of arthritis
  • Multiple fractures — patients with several broken bones often benefit from surgical stabilization to allow earlier mobilization
  • Failed non-surgical treatment — fractures that have displaced or lost alignment during casting

The Procedure

ORIF is performed under general or regional anesthesia. The surgeon makes an incision over the fracture site, carefully moves soft tissues aside to expose the bone, and uses specialized instruments to realign the fragments. Once the bone is in proper position, a metal plate is contoured to the bone surface and secured with screws. In some fractures, screws alone are sufficient without a plate. Fluoroscopy (real-time X-ray) is used during the procedure to confirm accurate alignment and hardware placement.

Most ORIF procedures are performed on the same day as the injury or within a few days, depending on swelling and the patient’s overall condition. Many can be done as outpatient surgery.

Recovery

Recovery after ORIF depends on the fracture location and severity. In general:

  • Weeks 1-2 — wound care, swelling management, and pain control; gentle range of motion exercises may begin
  • Weeks 2-6 — progressive rehabilitation with physical therapy; weight bearing is gradually advanced depending on the fracture
  • Weeks 6-12 — continued strengthening and return to daily activities as the bone heals
  • Months 3-6 — full return to sports or demanding activities for most fractures

Your surgeon will provide a specific recovery plan tailored to your injury and guide you through each phase of rehabilitation.

Frequently Asked Questions

What does ORIF surgery involve?
ORIF stands for open reduction internal fixation. The surgeon makes an incision to directly access the fracture, realigns the bone fragments into their correct anatomical position (open reduction), and secures them with metal plates and screws (internal fixation) so they remain aligned during healing.
Will the plates and screws need to be removed?
In most cases, the hardware can remain permanently. Removal may be recommended if the hardware causes discomfort, is prominent under thin skin, or needs to be replaced for any reason.
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