Before the procedure, talk to you doctor about ways to manage

factors that may increase your risk of complications such as:

 Smoking
 Drinking
 Chornic disease such as diabetes or obesity

How Long will it take:

An ORIF can take several hours depending on the
fracture and bone involved

Length of stay:
This procedure is done in a hospital setting. Your
length of stay will depend on your surgery. You may
be in the hospital for 1-7 days.

Hip and knee surgical instruments:

 Cement Removal instruments
 Curretes
 Elevators
 Forceps
 Hooks
 Orthopedic pliers
 Osteotomes and rasps
 Self-retaining retractors
 Hand-held retractors
 Rongeurs
 Spreadens

BY: Darlyn I. Amplayo

Open Reduction
and
Internal Fixation

.”
Definition:
Open reduction and internal fixation is a method of
providing exposure of the fracture site and using
pins, wire, screws, a plate and screw combinationsm
rods, or nails to correct the fracture
Open reduction and internal fixation is used when
when satisfactory reduction and internal fixation is
used when satisfactory reduction of a fracture
cannot be obtained or maintained by closed
methods, and skeletal traction is not indicated.
The advantage is that anatomic alignment of the
fracture can usually be obtained and verified
through direct observation.
Fractures that are comminuted or difficult to reduce
can be more effectively treated using this technique.
The incidence of infection and nonunion is
increased when the wound is opened.
The procedure varie for each anatomic site, utilizing
the principles for specific fixation devices. Several
procedures identify steps for completion of open
reduction and internal fixation: Examples include:
o Pin fixation- application of a unilateral
frame
o Wire fixation: reduction of patellar
fracture, tension banding of the olecranon
Screw fixation-correction of scaphoid
fractures
o Plate and screw fixation-repair of the
comminuted distal humeral fracture.
o Rod or nail fixation- correction of
fractures of the shaft of the humerus,
femoral shaft, or tibial shaft.
o The procedure
Repair of Fractures Instrumentation:
 Basic orthopedic tray

Surgeries Involving the Upper 
Small bone holder, nail set, drill bits, awl
Extremeties 
Power drill/cord
Fixation devices (e.g Steinman pins, k-wires, long screws,
PROCEDURE:
intramedullary nails, rush rods)
Perioperative Nursing Considerations
Open Reduction of the Humerus
 A long arm cast, with elbow in 90 degrees of flexion amd
Definition: Realignment and fixation of a fracture of the arm
the arm in neutral position is applied
necessatiting an operative incision
 Additional considerations—same with humerus
Discussion: A variety of fractures of the humerus may occur. If closed
reduction and immobilization are unsatisfactory or when there is
nonunion , fixation may be achieved by using a number of internal Surgeries Involving the lower
Fixation devices, including screws, rods, and compression plates. Extremeties
Positioning: Supine, affected arm in a comfortable position, unaffected
arm extended on an armboard ORIF-Fracture of the Femoral Shaft
Skin Prep: Definition: Realignment and fixation of a fracture of the femur through
an operative incision
Packs/Drapes:
 Extremity pack with fenestrated sheet Packs/Drapes: hip pack
 Impervious stockinette  Plastic adhesive drape sheet(optional)
 Eshmarch bandage, towels  If fracture table is not used, fenestrated sheet with adhesive
 Split sheet (optional) plastic drape
Instrumentation:  Towels, extra drape sheets
 Basic set Instrumentation:
 ESU/suction  Basic orthopedic tray
 Power source for drill  Drill bits, power drill/cord
 Tourniquet and insufflator (for distal fractures)(optional)  Fization device and tools specific to the device
 Sheet wadding/ casting materials Procedural overview:
 Blades-(2) No. 10 A posterolateral incision is made over the fracture site. The medullary
 Needle counter canal is reamed with special medullary reamers. A guide pin is driven
 Sutures- surgeon’s preference from the fracture site proximally to emerge subcutaneously just
 Solutions- saline, water proximal to the greater trochanter. The position of the guide pin in
 Medications- antibiotic (for irrigation) relation to the fracture is visualized by fluoroscopy. The internal
Perioperative Nursing Considerations: fixation devie is used to stabilize the fracture. A postpositional x-ray is
 Have x-ray capabilities in the room taken, and the device is securely seated once proper positioning has been
 Management of tourniquet determined. If the fracture site is comminuted, wire loops are placed
 Check tank levels for power equipment before beginning around the frag,ments. The wound is irrigated and clsed
Perioperative Nursing Considerations:
 Have adequate help to hold up and stabilize arm during  Have xray capabilities in the room
prepping and draping procedure  Notify x-ray department when patient is being positioned
 If distal fracture (near wrist), a hand table (side tension table) on the table. Observe radiologic precautions
may be used.  The extremity may be supported postperatively in the cast,
Related procedure: ORIF- supracondylar fixation-humerus depending on the location/severity of the fracture
 Some surgeons prefer to double glove during the draping
Open Reduction of the Radius and Ulna procedure and remove outer gloves following the draping
Definition: Realignment and fization of a fracture occurring in the segments
Forearm necessitating a surgical incision
Positioning: Supine, the affected arm is positioned across the chest or PROCEDURES OF THE LOWER EXTREMETIES (CONT.)
an extended arm hand table.  INTERNAL FIXATION OF THE HIP