What is elbow fracture open reduction and internal fixation?

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 3 bones. The humerus (the upper arm bone) forms the joint with 2 bones of the forearm: the radius and the ulna. The ulna forms the bony point of the elbow.

Different kinds of injury can damage any of the 3 bones that form the elbow joint. This is especially common when you fall on an outstretched hand. The bone may fracture into 2 or more pieces. In certain types of elbow fractures, your bone has broken, but its pieces still line up correctly. In other types of fractures (displaced fractures), the injury moves the bone fragments out of alignment.

If you fracture your elbow, you might need ORIF to bring your bones back into place and help them heal. During an open reduction, orthopedic surgeons reposition your bone pieces during surgery, so they are back in their proper alignment. In a closed reduction, a doctor physically moves the bones back into place without surgically exposing the bone.

Internal fixation refers to the method of physically reconnecting the bones. This might involve special screws, plates, wires, or nails that the surgeon places inside the bones to fix them in the correct place. This prevents the bones from healing abnormally. The entire operation usually takes place while you are asleep under general anesthesia.

Why might I need an elbow fracture open reduction and internal fixation?

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

Not everyone with a fractured elbow needs open reduction and internal fixation. 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 your fracture might not heal normally with these conservative treatments. You are likely to need ORIF if:

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

In these cases, ORIF can place your bones back into their proper configuration. This significantly increases the chance that your bone will heal properly.

You might need ORIF for a fracture that occurs anywhere in your elbow joint, including the lower part of your humerus and the upper parts of your radius or ulna.

What are the risks for an elbow fracture open reduction and internal fixation?

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

• Infection
• Bleeding
• Nerve damage
• Joint stiffness (common)
• Joint instability
• Bone misalignment
• Complications from anesthesia
• Broken screws or plates
• Arthritis of the joint (months to years later)

There is also a risk that the fracture won’t heal properly, and you’ll need a repeat surgery.

Your own risk of complications may vary according to your age, the anatomy of your elbow fracture, and your other medical conditions. For example, people with low bone mass or diabetes may be at greater risk of certain complications. Smokers may also have an increased risk. Ask your doctor about the risks that most apply to you.

How do I prepare for an elbow fracture open reduction and internal fixation?

ORIF often takes place as an emergency or urgent procedure. Before your procedure, a healthcare professional will take your medical history and do a physical exam. You’ll need an image of your elbow, probably obtained with an X-ray or magnetic resonance imaging (MRI). Tell your doctor about all the medicines you take, including over-the-counter ones like aspirin. Also, let your doctor know the last time you ate.

In some cases, your doctors might do your ORIF a little later. If so, talk to your doctor about how to prepare for the procedure. Ask whether you should stop taking any medicines ahead of time, such as blood thinners. You’ll need to avoid food and drink after midnight the night before your procedure.

What happens during an elbow fracture open reduction and internal fixation?

Your doctor can help explain the details of your particular surgery. The details of your surgery will depend on the location and severity of your injury. An orthopedic surgeon and a team of specialized healthcare professionals will do the surgery. The whole operation may take a couple of hours. In general, you can expect the following:

• You will receive general anesthesia, so that you’ll sleep through the operation and won’t feel any pain or discomfort during the procedure. (Or, you may receive a local anesthesia and a medicine to help you relax.)
• A healthcare professional will carefully monitor your vital signs, like your heart rate and blood pressure, during the operation. You may have a breathing tube inserted down your throat during the operation to help you breathe.
• After cleaning the affected area, your surgeon will make an incision through the skin and muscle of your elbow. (The specific site may vary according to the bone injured.)
• Your surgeon will bring the pieces of your fractured bone or bones back into alignment (reduction).
• Next, your surgeon will secure the pieces of the broken bone to each other (fixation). To do this, he or she may use screws, metal plates, wires, or pins. (Ask what the surgeon will use in your case.)
• Your doctor will make any other necessary repairs.
• After the team has secured the bone, your surgeon will surgically close the layers of skin and muscle around your elbow.

What happens after an elbow fracture open reduction and internal fixation?

Talk to your doctor about what you can expect after your surgery. You may have some pain after your procedure, but pain medicine may help decrease the pain. You should be able to resume a normal diet fairly quickly. You will probably get an imaging test done, like an X-ray, to make sure the surgery was successful. Depending on the extent of your injury and your other medical conditions, you might be able to go home the same day.

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

Your doctor might give you other instructions about caring for your arm, like applying ice. Follow all your doctor’s instructions carefully. Your doctor might not want you to take certain over-the-counter medicines for pain, 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.

You might see some fluid draining from your incision. This is normal. Let your doctor know right away if:

• You see an increase in redness, swelling, or draining from your incision
• You have a high fever or chills
• You have severe pain in your arm
• You have a loss of feeling in the arm or hand

Make sure to keep 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 your exercises as prescribed can improve your recovery. Most people are able to return to most of their normal activities within a few months.

Next steps

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• The name of the test or procedure
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• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
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• Who to call after the test or procedure if you have questions or problems
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