Open Reduction and Internal Fixation (ORIF) Hip

Open reduction and internal fixation (ORIF) is a surgery to repair a severely broken bone. Individuals with hip fractures may require ORIF to heal the injured bone. Although hip fractures are a major cause of concern for the elderly, the young may also get a hip fracture due to major road accidents and other severe traumas. According to research, hip fractures affect 18% of women and 6% of men globally. 

A hip fracture occurs when the femur or the thigh bone breaks near the hip joint. With the help of ORIF, the anatomy of the broken bone can be restored to normal, improving the range of motion.

ORIF surgery may benefit the patient in the following ways:-

1. Short duration of stay in the hospital
2. Relief from hip pain
3. High success rate for complete bone healing
4. Enhancing the range of motion of the leg
5. Ability to walk and engage in daily activities
6. Preventing further injury
7. Reduction in the risk of malunion (healing of the bone in improper position)

With age, the bones of the human body, especially the hip, get weak and are more prone to injuries. Which is why, people in old age require ORIF surgery for the hip. However, the surgery is not just subject to the old age demographic. Several physical traumas due to accidents often find the younger demographic in need of this surgery.

Patients with a hip fracture under the following circumstances may need an ORIF surgery:-

1. Bone cancer
2. Displaced intra-articular fracture (fracture extending from the bone to a nearby joint)
3. A type of displaced epiphyseal fracture 
4. Major avulsion fracture causing a loss of function of the hip joint
5. Non-healing (non-union) fracture
6. Delayed-healing (delayed-union) fracture
7. Motor vehicle accidents
8. Sports injuries 
9. Pathological fractures (bone fracture due to an underlying disease, e.g. osteoporosis)
10. Dislocation of the joint
11. Require assistance in nursing care
12. If adequate reduction (fracture repair) is not achieved or maintained 
13. Increased morbidity due to prolonged immobilisation 
14. If the closed reduction method is ineffective for a certain type of fracture

In case of a multiple fracture, the two ends of a broken bone may not line up properly. This could lead to malunion (healing of the bone in an abnormal position). In such cases as well, ORIF surgery is the go to option for treatment. 

If the surgery is not performed in time, it can cause intense pain in the outer upper thigh. Persistent pain and discomfort while rotating the hip can prevent the patient from getting up from bed for long periods. The fracture can also damage surrounding muscles, ligaments, blood vessels, and nerves. Due to this condition, the patient may experience the following complications: 

1. Blood clots in legs and lungs
2. Bedsores
3. Urinary tract infection
4. Loss of muscle mass

In case of a hip fracture, the patient needs an ORIF to properly align the bone so it can heal in the right position. ORIF is done in two parts: first is open reduction, followed by internal fixation. 

Open Reduction: An orthopaedic surgeon makes an incision in the thigh and repositions the bone pieces to get them back to their proper alignment during this procedure. In some cases, the orthopaedic surgeons suggest closed reduction. The closed reduction method is most effective when done immediately after the bone breaks. Unlike open reduction surgery, it is a procedure in which the surgeon physically moves back the bone to its normal position without cutting the skin. 

Internal Fixation: In this procedure, an orthopaedic surgeon fixes the bone by reconnecting the fragments internally. It requires implants such as nails, plates, screws, rods, or wires made of stainless steel and titanium as they are highly durable. The surgeon uses these implants to place them inside the patient’s bone so that it doesn’t heal in an abnormal position. These implants are highly compatible with the body and rarely cause an allergic reaction. 

1. A doctor physically examines the patient to check the severity of the injury. 
2. The patient needs to inform the doctor about all the medicines, including non-prescription medicines, such as Aspirin, he/she has been taking. 
3. The patient must also inform the doctor when was the last time he/she ate.
4. The injured leg may need to be placed in traction to hold it steady while he/she waits for the surgery. 
5. The patient must prepare necessary questions to ask the doctor regarding which medicines to take and avoid or if fasting is required before the surgery. 

The patient may also expect the following before the surgery:-

1. Blood test
2. X-ray
3. MRI
4. CT scan

1. After checking in at the hospital, the patient first signs the consent forms 
2. The patient is then made to change into a hospital gown
3. The healthcare providers monitor the patient’s vitals to check the blood pressure, heart rate, and blood oxygen level
4. The surgeon will explain the details of the procedure (specific to the patient)
5. The surgical site might be shaved.

1. The anaesthesiologist induces general or local anaesthesia, so the patient doesn’t feel any pain during the procedure. 
2. Health care providers monitor the patient's vitals to check the patient's heart rate and blood pressure. 
3. They may also insert a tube down the patient’s throat during the surgery so that the patient can breathe comfortably.
4. The surgeon will clean the surgical area to make an incision through the skin and muscles of the thigh.
5. After making an incision, the surgeon aligns the pieces of the femur in their normal position (open reduction).
6. Then, he/she sets the pieces together (fixation). During fixation, the surgeon may use screws, pins, metal plates, or wires to hold it together. 
7. In case of a fracture in the middle part of the femur, the surgeon may use a long metal rod that passes through the middle of the bone and gets screwed into the bone at both ends. 
8. If required, the surgeon may make some other repairs. 
9. After the surgery is complete, he/she closes the incisions with the help of sutures or stitches.

If the patient experiences the following symptoms, he/she must call a doctor immediately. 

1. Fever over 101.5°F
2. Severe pain even after taking medication
3. Increased redness and inflammation around the wound
4. Irritated skin or sores
5. Toes becoming cold, pale, or swollen
6. Drainage from the wound
7. Bleeding
8. Irregular breathing

Risks and Complications 

Potential risks and complications in treating the hip fracture may include:-

1. Post-surgery infection
2. Bleeding that may require transfusion
3. Allergic reaction to anaesthesia 
4. Nerve damage that can cause numbness in the leg
5. Hardware (including metal plates/rods) moving out of place
6. Pain and swelling in the leg
7. Incomplete healing of the bone
8. Muscle spasm
9. Blood clotting
10. Compartment syndrome (increased pressure in the leg that can cause damage to the muscle and tissue)

The following conditions might lead to complications after the surgery: 

1. Obesity
2. Diabetes
3. History of blood clotting
4. Rheumatoid arthritis