What is open reduction and internal fixation for an upper arm fracture?

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 arm.

The humerus is the bone in the upper part of your arm. Different kinds of injury can damage this bone. This usually results from a direct blow to the arm from a fall or collision, causing it to fracture into two or more pieces. This might happen in the part of the humerus near your shoulder, near the middle of the humerus, or in the part of the humerus near your elbow. In certain types of humerus fractures, your humerus is broken but its pieces still line up correctly. In other types of fractures (displaced fractures), the injury moves the bone fragments out of position.

If you fracture your humerus, you might need ORIF to bring your bones back into place and help them heal. During an open reduction, orthopedic surgeons reposition the pieces of your fractured bone surgically so that your bones are back in their correct position. In a closed reduction, a healthcare provider moves the bones back into place without surgically exposing the bone.

Internal fixation refers to the method of reconnecting the bones. This method uses special screws, plates, wires, or nails to align the bones correctly. This prevents the bones from healing abnormally. The surgery usually takes place while you are asleep under general anesthesia.

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

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

Not everyone with a fractured humerus needs ORIF. In fact, most people don’t. If possible, your healthcare provider will treat your arm fracture with other 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 other treatments. You are likely to need ORIF if:

• The pieces of your humerus are severely out of alignment

• Your humerus broke through the skin

• Your humerus broke into several pieces

In these cases, ORIF can align your bones back into the right position. This greatly increases the chance that your bone will heal normally.

You might need ORIF for a fracture that occurs anywhere along your humerus, including the portions near the shoulder and the elbow.

In some cases, your healthcare provider might discuss other surgical choices with you, like a shoulder replacement if you have severe damage to the top of your humerus. Talk to your healthcare provider about the risks and benefits of all your choices.

What are the risks of upper arm fracture open reduction and internal fixation?

Most people do very well after ORIF. But rare complications can sometimes occur. Possible complications include:

• Screw perforation of the humeral head

• Broken screws or plates

• Infection

• Bleeding

• Nerve damage

• Tissue death due to low blood supply (avascular necrosis) in the humerus

• Loss of range of motion

• Bone out of position, or failure to heal

• Complications from anesthesia

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

Your own risk of complications may vary according to your age, how and where your humerus breaks, and your other health conditions. For example, people with low bone mass or diabetes may be at higher risk of complications. Being a smoker may also increase your risk. Ask your healthcare provider about the risks that most apply to you.

How do I get ready for upper arm fracture open reduction and internal fixation?

ORIF often takes place as an urgent procedure. Before your procedure, a healthcare provider will ask about your medical history and give you a physical exam. You’ll have an image of your humerus taken, probably with an X-ray, CT scan or MRI. Tell your surgeon about all the medicines you take, including over-the-counter medicines like aspirin. Also, let your surgeon know the last time you ate.

In some cases, your surgeons might do your ORIF as a planned procedure. If this is the case, you should talk to your surgeon about how you can prepare. Ask if you should stop taking any medicines ahead of time, like blood thinners. You’ll need to not eat or drink after midnight the night before your procedure.

What happens during upper arm fracture open reduction and internal fixation?

Your surgeon can help explain the details of your surgery. The details of your surgery will depend on the location and how bad your injury is. An orthopedic surgeon assisted by a team of specialized healthcare providers will do the surgery. The surgery may take a couple of hours. In general, you can expect the below:

• You may receive general anesthesia, so that you’ll sleep through the operation and won’t feel anything. (Or you may receive local anesthesia and a medicine to help you relax.)

• A healthcare provider will carefully watch your vital signs, like your heart rate and blood pressure. You may have a breathing tube inserted down your throat during the surgery to help you breathe.

• After cleaning the affected area, your surgeon will make an incision through the skin and muscle of your arm. For certain types of injuries, your surgeon might make an incision through the top of your shoulder instead.

• Your surgeon will bring the pieces of your humerus back into position (reduction).

• Next, your surgeon will secure the pieces of humerus to each other (fixation). To do this, they may use screws, metal plates, wires, and pins. For a fracture in the middle of your upper arm, a special metal rod may be put through the middle of the bone. It screws into the bone at both ends. Ask what the surgeon will use in your case.

• Your surgeon will make any other necessary repairs.

• After the team has secured the bone, your healthcare provider will surgically close the layers of skin and muscle around your arm.

What happens after upper arm fracture open reduction and internal fixation?

Talk to your surgeon about what you can expect after your surgery. You may have a lot of pain after your procedure, but pain medicine may help to reduce the pain. You should be able to resume a normal diet fairly quickly. You will probably have imaging done, like an X-ray, to make sure that 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.

Many patients will begin exercises to improve motion shortly after surgery. Depending on how bad your fracture is and the type of surgery you had, you may be restricted from certain activities, such as lifting, pushing, or pulling activities (including opening or closing doors), with your injured arm for some time. You’ll receive instructions about how you can move your arm. You may need to wear a splint or cast for several weeks. Make sure to protect it from water.

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

You might have some fluid draining from your incision. This is normal. Let your healthcare provider 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 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 some sort of physical therapy to restore strength and flexibility to your muscles. Doing your exercises as prescribed can improve your chances of a full recovery. Most people are able to return to all their normal activities within a few months.

Next steps

Before you agree to the 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 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

• 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 will have to pay for the test or procedure