ORIF (Open Reduction Internal Fixation)
Open reduction and internal fixation (ORIF) is a surgical technique used to repair broken bones that cannot be treated with a cast or external splint alone. The surgeon makes an incision, manually repositions the bone fragments (reduction), and secures them with metal hardware — plates, screws, rods, or wires — that stays in the body permanently. ORIF is used for fractures that are displaced, unstable, involve a joint surface, or have failed non-surgical management. Common sites include the ankle, wrist, tibia, femur, humerus, clavicle, and acetabulum.
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Who Needs ORIF (Open Reduction Internal Fixation)?
Patients with fractures that are out of alignment and cannot be held in place by a cast, fractures involving the joint surface (which require precise anatomical reduction to prevent arthritis), open fractures (where bone has broken through skin), and fractures in active patients where faster mobilization matters. Some fractures with good alignment are still treated surgically when the anatomy makes casting impractical or when weeks of immobilization carry more risk than surgery.
What to Expect
Recovery Timeline
Elevation and pain management. Non-weight-bearing for most lower extremity fractures. Follow wound care instructions.
Wound check and suture removal. Begin range-of-motion exercises for adjacent joints if cleared. Continue weight-bearing restrictions.
Follow-up X-rays assess healing. Progressive weight-bearing often begins when bone callus is visible on imaging.
Physical therapy for strength and range of motion. Most patients begin walking without assistive devices for ankle and wrist fractures by this point.
Return to normal activity for most fractures. High-demand work or sport may require up to 6 months. Follow-up X-rays confirm complete healing.
Risks & Complications
- Infection, including deep infection around hardware
- Hardware failure or breakage before healing is complete
- Non-union (bone fails to heal) requiring revision surgery
- Malunion (bone heals in imperfect position)
- Stiffness in adjacent joints
- Nerve or blood vessel injury
- Post-traumatic arthritis if the fracture involves a joint surface
- Symptomatic hardware requiring removal after healing
Frequently Asked Questions
Does the hardware need to come out after the bone heals?
Not routinely. Most ORIF hardware stays in permanently. It is only removed if it causes symptoms: prominent hardware under thin skin that is painful with pressure, hardware that irritates tendons, or infection around the implant. Removal is an elective procedure done after the bone has fully healed, typically no sooner than 12-18 months post-ORIF. Some patients with ankle and forearm hardware do elect removal because the screws are close to the skin surface.
Will I set off metal detectors after ORIF?
Titanium implants (the most common material) are not magnetic and will not trigger airport security scanners. Stainless steel hardware occasionally triggers detectors but this is rare with modern implants. Your surgeon can provide a letter describing your implants if you travel frequently or work in a secure facility.
What is the difference between ORIF and casting?
Casting holds the bone from the outside and works well for fractures that are minimally displaced and stable in their position. ORIF directly secures the fragments from inside, which is needed when a cast cannot hold the alignment or when the fracture involves a joint surface that has to be reconstructed precisely. ORIF typically allows earlier motion of the joint than casting because the hardware provides internal stability while the bone heals.
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Compare orthopaedic surgeons who perform this procedure.
Search surgeonsEstimated Cost
$15,000 - $50,000 depending on the bone, complexity, and facility. Hardware costs vary widely. Most trauma fractures that require surgery are covered by insurance. Cost is higher for complex periarticular fractures requiring specialized implants.
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This information is for educational purposes only. Costs are estimates and vary by location, surgeon, and insurance. Always consult a qualified healthcare provider.