What is hip fracture open reduction internal fixation?
Hip open reduction internal fixation is a type of hip fracture treatment. Broken or fractured hips are common injuries, especially as we age. Every year, more than 300,000 people older than 65 are hospitalized because they have broken a hip, according to the Centers for Disease Control and Prevention. The most common type of hip fracture occurs when the top of your femur, the long bone between your knee and hip, breaks. Surgery to fix this type of hip fracture is open reduction internal fixation, or ORIF surgery.
The term ’open reduction’ refers to the surgery itself. An orthopedic surgeon makes an incision to expose the bone and manipulate it back into place (reduce the fracture). Hip ’internal fixation’ refers to how the bone pieces are held together once they are put back into place—the surgeon uses orthopedic screws, plates, wires or rods, or a combination to internally fix the fracture.
Why is ORIF hip surgery performed?
Hip ORIF is usually an emergency surgery, performed as soon as possible after the fracture. The procedure stabilizes the broken bone and allows it to heal. ORIF hip surgery repairs the break in the top part of your femur, the ball that fits into the hip socket.
Surgery is the most common treatment for a hip fracture, although there are some situations when surgery isn’t advised. Some people may not tolerate open surgery well. For people who are no longer able to walk, ORIF surgery to repair a hip fracture would not improve their quality of life.
Most people who fracture the top part of their femur do have hip ORIF surgery so they can resume their normal activities once the bone heals. ORIF is also a possible treatment for other types of hip and pelvic fractures, such as an acetabular fracture. The acetabulum is the socket, or cup part of the hip joint that cradles the femur head.
Who performs ORIF surgery for hip fractures?
Hip fracture surgery is performed by an orthopedic surgeon. Orthopedic surgeons are specialists in the musculoskeletal system—everything that makes your body work mechanically—including the bones, joints, ligaments, muscles, nerves and tendons. Some surgeons specialize in joint repair and replacements, while others focus on other aspects of the musculoskeletal system. A surgeon who specializes in orthopedic trauma and hip fracture may likely perform your ORIF surgery.
How is hip fracture ORIF performed?
Doctors perform open reduction internal fixation surgery in a hospital, most often with the patient under general anesthesia. However, your doctor may choose to give you a regional anesthetic—such as an epidural block—which numbs your body from the waist down. Regional anesthesia is not common for hip surgery, but is preferred if you have health issues that general anesthesia may affect. If you have surgery with regional anesthesia, your provider will give you medicine to sedate you throughout the surgery.
What to expect
In general, this is what happens the day of your surgery:
The orthopedic surgical staff will prepare you for surgery and your anesthesia provider will explain your anesthesia.
A surgical staff member will bring you to the operating room.
If you don’t yet have an intravenous (IV) line, a nurse or technician will insert one. They use the IV line to give you fluids and medications.
You will receive a sedative to help you sleep. If you are having a general anesthetic, you may be on a ventilator to help you breathe throughout the surgery.
Your surgeon makes an incision in the side of your hip to access the broken bone. The surgeon removes bone fragments, repairs any soft tissue damage, moves the broken bones back into place, and secures them with hardware—metal screws, plates or wires.
You will have internal sutures (stitches) in the soft tissues like muscle as well as at the surgical incision.
A surgical assistant will bring you to a recovery room to monitor your vital signs as you wake up. You may already be in a regular hospital room by the time the anesthetic wears off.
The whole procedure can take 2 to 4 hours.
What are the risks and potential complications of hip ORIF?
All surgeries have some risk associated with them. If you have a choice of hip fracture treatments, discuss the benefits and risks of ORIF with your surgeon.
General risks associated with any type of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing. Anesthesia can also cause confusion or delirium, particularly among older and elderly populations.
Bleeding within the surgical area or at the incision
Blood clots, in particular a deep vein thrombosis, which can cause a pulmonary embolism
Infection
Potential complications of hip fracture ORIF
ORIF surgeries are quite common with the high number of hip fractures that occur every year. Despite this, complications are possible including:
Failure of the bone to heal
Nerve damage from the fracture itself or the procedure
Fat embolism, which is when some fat tissue leaks from the bone marrow and like a blood clot, it can travel to other parts of your body and cause a pulmonary embolism, heart attack or stroke.
Hardware failure, such as breakage of wires, screws, and other implants
Irritation from the hardware if it rubs against the tissues
Pressure sores from prolonged bedrest during recovery
Urinary tract infections. Many patients who have hip fracture repair surgery also have a urinary catheter for a few days after surgery. The catheter could increase your risk of developing a urinary tract infection.
Reducing your risk of complications
You can reduce your risk of certain complications by:
Getting up out of bed as soon as your healthcare team says you can, and moving about in your bed as much as possible, to protect your skin and strengthen your muscles. Tell your nurse and doctor if you are too uncomfortable to move about.
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have allergies or sensitivities
How do I prepare for hip ORIF?
Because ORIF hip surgery is usually an emergency or urgent surgery, there is little preparation you can do in advance of the procedure. Your healthcare team will take X-rays of your hip to evaluate the extent of the fracture and plan the surgery. The orthopedic surgeon will ask about your medical history, including if you have any allergies or are taking medications, particularly anticoagulants (blood thinners). Your team will also want to know when you last had anything to eat or drink.
If there is a delay getting you to surgery, your leg may be put in traction while you wait, to prevent the femur from moving towards your hip socket.
Questions to ask your doctor
It may be difficult to think of questions to ask the surgeon when you are in pain and possibly stressed. However, if you ask these questions, you may have a better understanding of the procedure and what will happen afterwards:
Is this the best surgery for my type of hip fracture?
Will it be done under general anesthesia or regional anesthesia?
How long will I have to stay in the hospital after the surgery?
Can I go home after the surgery or will I have to go to a rehabilitation facility?
Should I resume taking my medications after the surgery?
Will I have to take an anticoagulant after the surgery and if so, for how long?
Will I have to take any special precautions while taking an anticoagulant?
When will the stitches or staples be removed?
What type of follow-up care will I need? Are there ORIF precautions specific to the hip?
What can I expect after hip ORIF?
Undergoing urgent or emergency surgery for a fractured hip is usually stressful but knowing what to expect can help you plan ahead.
How long it takes to recover depends on the extent of the fracture and your overall health. If you have other medical problems, other doctors may visit you in the hospital or want to see you for follow-up care afterwards. Speak with the surgeon about your expected recovery time and treatment plan.
A physical therapist will help you learn leg exercises and teach you how to get out of bed and begin walking. If necessary, an occupational therapist may visit to assess if you may need any special equipment at home, such as an elevated toilet seat.
Will I feel pain?
There is usually a significant amount of pain with a hip ORIF surgery, but most people say it is less than the pain they had from the fracture itself. Don’t be afraid of taking analgesics (pain relievers) while you are healing, especially in the first few days. It’s important for you to move as much as possible. If you are in too much pain, you may limit that movement. As your incision and bones heal, the pain will ease and you will need less pain relief.
When should I call my doctor?
Discuss follow-up appointments while you are still in the hospital, but call your doctor right away or seek immediate medical care if you have:
Increasing pain or the pain does not go away
Increasing redness or swelling around the incision, oozing from the incision, high fever, or chills
Loss of feeling or decreased feeling in the affected leg
Sudden difficulty breathing, confusion, or chest pain
How might hip fracture open reduction and internal fixation affect my everyday life?
Shortly after ORIF surgery, you may need help around the house to help you with your everyday activities, such as preparing meals and doing laundry. Full recovery from an ORIF surgery may take up to 4 to 6 months, but most people are able to resume many of their daily activities well before that. Take your time and build up your strength, giving your bone the opportunity to fully heal.