Elbow Fracture Open Reduction and Internal Fixation (ORIF)

Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. You might need this procedure to treat your broken elbow.

The elbow joint is a hinge type of joint composed of three bones. The humerus (the upper arm bone) forms the joint with two bones of the forearm: the radius and ulna. The ulna forms the bony point of the elbow.

Different kinds of injuries can damage any of the three bones that form the elbow joint. This is especially common when you fall on an outstretched hand. One of the bones may fracture into two or more pieces. Sometimes a bone breaks but its pieces still line up correctly. Sometimes the injury moves the bone pieces out of alignment (displaced fracture).

You might need ORIF to bring the bones back into place and help them heal. The surgery is done by an orthopedic surgeon. This is a doctor who specializes in treating bone, muscle, joint, and tendon problems. During open reduction surgery, the surgeon makes a cut (incision) in or near the elbow and moves the bone pieces back into the correct position. In a closed reduction, a doctor moves the bones back into place without making an incision.

Internal fixation is a method of reconnecting the bones. This might be done with special screws, plates, rods, wires, or nails. The surgeon puts these into the bones to hold them in the correct position. This prevents the bones from healing in an abnormal way. The surgery usually takes place while you are asleep under general anesthesia.

Certain medical conditions may make fracturing your elbow more likely. For example, osteoporosis increases the risk of fractures in many older adults.

Not everyone with a fractured elbow needs ORIF. In fact, most people don't. If possible, your doctor will treat your elbow fracture with more conservative treatments, like pain medicine, splints, and slings.

You probably won't need ORIF unless there is some reason that your fracture might not heal normally with these treatments. You're more likely to need ORIF if:

• The pieces of your broken bone are very out of alignment.
• Your broken bone pierced through the skin.
• Your bone broke into several pieces.

In these cases, ORIF can place the bones back into the right position. This increases the chance that your bone will heal the right way. You might need ORIF for a fracture that occurs anywhere in your elbow joint. This includes the lower part of your humerus and the upper part of your radius or ulna.

Most people do very well with ORIF for their elbow fracture. Although rare, problems can occur. Possible problems include:

• Infection.
• Bleeding.
• Nerve damage.
• Joint stiffness (common).
• Joint instability.
• Bones that remain out of position or do not heal well.
• Broken screws or plates.
• Arthritis of the joint (months to years later).
• Pain or irritation in the skin and muscles that cover the screws and plates.
• Problems from anesthesia.

There is also a risk that the fracture won't heal in the right way and you'll need another surgery.

The risk of problems may vary based on your age, the kind of elbow fracture you have, and any other health conditions you have. For example, people with low bone mass or diabetes may be at greater risk for certain problems. People who smoke may also have an increased risk. Ask your doctor about the risks that most apply to you.

ORIF often is done as an urgent procedure. Before your procedure, the doctor will ask about your medical history and do a physical exam. You'll have an image taken of your elbow. This may be an X-ray, CT scan, or MRI. Tell your doctor about all the medicines you take, including over-the-counter medicines like aspirin. Also tell your doctor the last time you ate.

Sometimes ORIF is done as a planned procedure. If so, talk with your doctor about how to prepare for the procedure. Ask if there are any medicines you should stop taking ahead of time, like blood thinners. Follow any directions you are given about when to stop eating and drinking before your procedure.

The surgeon can explain the details of your surgery. The details will depend on where the injury is and how severe it is. An orthopedic surgeon and trained assistants will do the surgery. An anesthesiologist will make sure you don't feel pain during the surgery. The surgery may take a couple of hours. In general, here's what to expect:

• You may get general anesthesia, so you'll sleep through the surgery and won't feel anything. Or you may get local anesthesia and a medicine to help you relax.
• Your heart rate, blood pressure, and other vital signs will be carefully watched. You may have a breathing tube placed down your throat during surgery to help you breathe.
• After cleaning the affected area, the surgeon makes a cut (incision) through the skin and muscle of your elbow area.
• The surgeon brings the pieces of your fractured bone or bones back into alignment (reduction).
• Next, the surgeon fastens the pieces of the broken bone or bones together (fixation). They may use screws, metal plates, wires, or pins. (Ask what the surgeon will use for your surgery.)
• The surgeon may make other needed repairs.
• After the bones are secured, the layers of skin and muscle around your elbow are closed up with stitches or staples.

Talk to your doctor about what to expect after surgery. You will have some pain. But pain medicine can help reduce the pain. You should be able to go back to a normal diet quickly. You'll likely need an imaging test, such as an X-ray, to make sure the surgery was successful. Depending on how severe your injury is and any other health conditions you have, you might be able to go home the same day.

For a while after your surgery, you'll need to keep your arm from moving. Often, this means wearing a splint for several weeks. Be sure to protect your splint from water. You'll receive instructions about how you can move your arm.

The doctor might give you other instructions about caring for your arm, like applying ice. Follow all of your doctor's instructions carefully. Your doctor might not want you to take certain over-the-counter medicines for pain. That's because some of these can interfere with bone healing. Your doctor may advise you to eat a diet high in calcium and vitamin D as your bone heals.

After surgery, some fluid may drain from your incision. This is normal. Contact your doctor right away if:

• You have an increase in redness, swelling, or drainage from your incision.
• You have a high fever or chills.
• You have severe pain in your arm.
• You have a loss of feeling in your arm or hand.
• You have swelling, redness, or pain that gets worse in your arm.
• You have shortness of breath, chest pain, or a racing heart even with rest.

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

At some point, you may need physical therapy to restore strength and flexibility to your muscles. Doing the exercises as prescribed can improve your chances for a full recovery. Most people are able to return to most of their normal activities within a few months.

Before you agree to have a test or procedure, make sure you know:

• The name of the test or procedure.
• The reason you are having the test or procedure.
• What results to expect and what they mean.
• The risks and benefits of the test or procedure.
• What side effects or problems are possible.
• When and where you will have the test or procedure.
• Who will do the test or procedure and what that person's qualifications are.
• What may happen if you don't have the test or procedure.
• Whether there are any alternative tests or procedures to think about.
• When and how you will get the results.
• Who to call after the test or procedure if you have questions or problems.
• How much you may need to pay for the test or procedure.