Open Reduction and Internal Fixation (ORIF): Procedure, Recovery, and Risks
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 17, 2026
Open reduction and internal fixation (ORIF) is surgery to repair broken bones: a surgeon realigns the pieces and holds them in place with metal fasteners so the bone heals correctly [1].
Quick Answer: What is ORIF surgery?
Open reduction and internal fixation (ORIF) is a surgery in which a surgeon makes incisions to realign a broken bone, then holds it with rods, screws, wires or plates. It is used for severe fractures that will not heal correctly in a cast alone. Recovery ranges from several weeks to a year or longer, and risks include infection and nonunion. [1]
What the research says
Smoking raises the risk of infection after ORIF. A meta-analysis of 16 studies (41,944 patients) of closed ankle and calcaneus (heel bone) fractures found that smokers had higher odds of surgical site infection after ORIF (OR 1.62), with the link clear for deep infections (OR 2.09) but not superficial ones (Tran et al., EFORT Open Rev, 2024).
Open reduction carries a higher infection risk than closed reduction in one fracture type. In a systematic review of 21 studies of displaced femoral neck fractures in young adults, deep wound infection occurred in 3.9% after open reduction versus 0.49% after closed reduction, while nonunion and avascular necrosis rates did not differ significantly. The authors noted a lack of high-quality trials (Ghayoumi et al., Injury, 2015).
What Is ORIF Surgery?
ORIF is surgery to repair broken bones. An orthopedic surgeon realigns (sets) the bones to their correct position and secures them so they can heal and grow back together [1]. A bone that does not heal properly is much more likely to break again in the future, and ORIF gives the bone the best chance to heal without long-term complications [1].
Which Fractures Need ORIF?
Not every broken bone needs ORIF, but compound, comminuted and displaced fractures are more likely to need this surgery. These types are more likely to need surgery [1]:
Fracture type | Description |
Compound (open) fracture | The bone breaks through the skin; infection risk is higher |
Comminuted fracture | The bone is broken into several pieces |
Displaced fracture | The pieces of bone have moved enough to form a gap |
The three main fracture types that may call for ORIF: compound, comminuted, and displaced.
What happens before open reduction and internal fixation (ORIF) surgery?
Fractures are usually caused by trauma such as falls, car accidents, or sports injuries, so there is sometimes little time to plan. After an emergency team stabilizes you and treats life-threatening injuries first, X-rays confirm the fracture, and an MRI or CT scan may be used to look for other injuries. What happens next depends on the bone, the fracture pattern and severity, its cause, and any other injuries [1].
How is open reduction and internal fixation (ORIF) surgery performed?
An anesthesiologist gives general anesthesia (you sleep) or regional anesthesia (the area around the broken bone is numbed), sometimes with other medicines to help you sleep [1]. The surgeon then:
Makes incisions in the skin around the broken bone
Sets the bone and realigns the broken pieces
Performs the internal fixation to hold the pieces in place, in a way that depends on the fracture type
Closes the incisions
Immobilizes the bone, usually with a cast, or sometimes only a splint
Types of Fixation
Fastener | Example use |
Rods | A long titanium rod placed through the center of a long bone, such as the shin bone (tibia) |
Plates and screws | Metal plates screwed into either side of the ankle to repair a broken ankle |
Wires | Used alone or with other fasteners to secure the pieces |
Surgeons may use rods, screws, wires, plates, or a combination of these. ORIF usually takes at least a few hours, depending on the fracture type and bone; larger bones and more severe fractures take longer [1].
Right After Surgery
You are moved to a recovery room, where the team watches you for a few hours to make sure you recover from anesthesia without complications and monitors your vital signs and pain. Some people go home the same day; others stay overnight or for a few days, especially with other injuries [1].
What are the benefits and success rate of open reduction and internal fixation (ORIF)?
Studies consistently find that ORIF is the best way to treat severe fractures that will not heal with only immobilization. Success rates depend on the bone and the fracture pattern. Even for rare, complex fractures such as a broken femur, one study found that around 75% of people had few or no long-term complications [1].
What are the risks and complications of open reduction and internal fixation (ORIF)?
Risks of open reduction and internal fixation (ORIF) include acute compartment syndrome, malunion, nonunion, bone infection and blood clots.
Acute compartment syndrome: pressure buildup in the muscles can stop blood reaching tissue, causing permanent muscle and nerve damage.
Malunion: the bone heals without lining up correctly.
Nonunion: the bone does not grow back together fully or at all.
Bone infection (osteomyelitis): the risk is higher with open fractures.
Blood clots: ORIF can increase clot risk in blood vessels near the broken bone during recovery.
Source: Cleveland Clinic [1].
What is recovery like after open reduction and internal fixation (ORIF)?
Recovery after open reduction and internal fixation (ORIF) depends on the fracture and the surgery, ranging from several weeks to a year or longer. Some fractures heal in several weeks, while more severe breaks can take a year or longer, and you will probably wear a cast or splint for at least a few weeks [1]. In general you should:
Elevate the bone above the level of your heart as often as possible, for example propped on pillows
Keep the incision clean and covered, and ask when to change the dressing and when it is safe to shower or bathe, especially with a cast
Work with a physical therapist for up to a few months, following your surgeon's instructions on how to move safely
Use crutches or other assistive devices for a few weeks if needed
Pain Management
Expect pain, especially in the first few weeks, from both the surgery and bone healing. Your surgeon will suggest prescription pain medication, over-the-counter NSAIDs if safe for you, and acetaminophen, and will tell you how much of each to take. Talk to your surgeon if pain is too much or you worry about the medication [1].
Are the Screws and Plates Permanent?
It depends on where the fixation was placed. Some people keep the metal for life, and screws and plates around joints (especially ankles) often stay. As the bone heals, the body can push fasteners closer to the skin, so tell your surgeon about pain or other symptoms near the implants [1].
When should you call your surgeon after open reduction and internal fixation (ORIF)?
Call your surgeon or healthcare provider right away for [1]:
Chest pain
Shortness of breath
Fever higher than 101 °F (38.3 °C)
Bleeding
Signs of infection at the surgery site: leaking, swelling, discoloration, odor, or warmth
Severe pain that does not get better with pain medication. For chest pain or sudden shortness of breath, which can mean a blood clot in the lungs, call 911 or your local emergency number.
What is the bottom line on open reduction and internal fixation (ORIF)?
ORIF repositions a severely broken bone and holds it with metal implants so it heals in the correct shape and position. Recovery takes effort, with elevation, wound care, and physical therapy, but ORIF is one of the best ways to restore a severe fracture. Ask your surgeon which type of ORIF is best for you and how long the implants will stay [1].
Frequently Asked Questions
Is the metal hardware permanent?
It depends on where the fixation was needed. Some people keep the implants forever, and screws and plates around joints, especially the ankles, often stay for life. Some people need another surgery to remove them. If you notice pain or other symptoms near the implants, talk to your surgeon.
How successful is ORIF surgery?
ORIF is usually very effective, though success depends on the bone and the fracture pattern. Cleveland Clinic cites one study in which around 75% of people who had ORIF for a fractured femur had few or no long-term complications.
How long does the surgery take?
ORIF usually takes at least a few hours from start to finish. Larger, longer bones or more severe fractures usually take longer to repair.
When can I start walking again?
It depends on which bone was broken and your surgeon's instructions. You may need a cast or splint for at least a few weeks, and crutches or other assistive devices for a few weeks after ORIF. Your surgeon gives you a customized recovery plan.
Will I have a scar?
Open reduction requires incisions in the skin around the broken bone, so a scar is expected. Its size and location depend on the bone and the surgical approach. Ask your surgeon what to expect.
How is ORIF different from a cast?
A splint or cast alone works for fractures that will heal in good position. Severe fractures that will not heal correctly with only immobilization need ORIF, which repositions the bone and holds it with metal fasteners. A cast or splint is often still used after ORIF.
Can I get an MRI with ORIF implants?
Implants are metal, so tell your imaging team about any hardware before a scan. They can check whether it is safe to scan with your specific implant.
How do I manage pain at home?
Your surgeon will suggest a combination of prescription pain medication, over-the-counter NSAIDs if safe for you, and acetaminophen, and will tell you how much to take. Pain is worst in the first few weeks, and elevating the limb above heart level also helps.
What are the signs of an infection?
Call your surgeon right away for fever higher than 101 °F (38.3 °C), or leaking, swelling, discoloration, odor, or warmth at the surgery site. Also call for bleeding, chest pain, shortness of breath, or severe pain that does not improve with medication.
How long will I need physical therapy?
You may work with a physical therapist for up to a few months after surgery. Your surgeon will explain how to move safely before you go home.
How do I prepare for ORIF surgery?
Because fractures usually follow trauma such as a fall, car accident or sports injury, there is often little time to plan. An emergency team stabilizes you and treats any life-threatening injuries first, X-rays confirm the fracture, and an MRI or CT scan may be used to look for other injuries. What happens next depends on the bone, the fracture pattern and severity, its cause and any other injuries [1].
Does ORIF hurt, and what anesthesia is used?
You will not feel the surgery. An anesthesiologist gives general anesthesia (you sleep) or regional anesthesia that numbs the area around the broken bone, sometimes with other medicines to help you sleep. Expect pain afterward, especially in the first few weeks, which your surgeon manages with prescription pain medication, over-the-counter NSAIDs if safe for you, and acetaminophen [1].
Related Resources
Related reading on Rinnit:
External resources for deeper reading:
Related Reading
References
Cleveland Clinic. Open reduction and internal fixation (ORIF). Cleveland Clinic Health Library. Medically reviewed; last updated July 29, 2024. https://my.clevelandclinic.org/health/procedures/open-reduction-and-internal-fixation-orif
Tran DNA, Nguyen BTT, Nguyen TT, et al. Adverse effect of smoking on surgical site infection following ankle and calcaneal fracture fixation: a meta-analysis. EFORT Open Rev. 2024;9(8):817-826. PMID: 39087505. DOI: 10.1530/EOR-23-0139
Ghayoumi P, Kandemir U, Morshed S. Evidence based update: open versus closed reduction. Injury. 2015;46(3):467-473. PMID: 25554424. DOI: 10.1016/j.injury.2014.10.011
Medical disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have about a medical condition.
Comments