Arm Fracture Open Reduction and Internal Fixation (ORIF)

Arm Fracture Open Reduction and Internal Fixation (ORIF)

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Arm Fracture Open Reduction and Internal Fixation (ORIF)

Open reduction and internal fixation (ORIF) is a type of treatment to fix a broken bone. It puts the pieces of a broken bone back together so they can heal. Open reduction means the bones are put back in place during surgery. Internal fixation means that special hardware is used to hold the bone pieces together. This helps the bone heal correctly. The procedure is done by an orthopedic surgeon. This is a doctor with special training in treating bone, joint, and muscle problems.

Understanding an arm fracture

The humerus is the bone in the upper part of your arm. An injury may cause it to break (fracture) into 2 or more pieces. Your humerus may be broken near your shoulder, in the middle of your upper arm, or near your elbow. The humerus can break with the pieces lined up correctly. Or the pieces of bone may not be lined up correctly. This is called a displaced fracture.

You are likely to need ORIF if:

  • You have a displaced fracture

  • Part of your humerus broke through the skin

  • Your humerus broke into several pieces

Risks of arm fracture ORIF

All surgery has risks. The risks of arm fracture ORIF include:

  • Damage to the humerus from screws

  • Broken screws or plates

  • Infection

  • Bleeding

  • Nerve damage

  • Death of part of the humerus (avascular necrosis)

  • Loss of movement

  • Misaligned bone

  • Need for additional surgery

  • Problems from anesthesia

Your risks vary based on your age and general health. For example, if you are a smoker or if you have low bone density, you may have a higher risk for certain problems. People with diabetes that is not controlled well may also have a higher risk for problems. Talk with your health care provider about which risks apply most to you.

Getting ready for your surgery

ORIF often takes place as emergency surgery after an accident or injury. You’ll have a physical exam. X-rays may be taken of your arm. You may also have other imaging tests. A health care provider will ask you questions. He or she will also check your heart and lungs. Make sure you tell the health care provider about all medicines you take, including over-the-counter (OTC) medicines, such as aspirin. Also, tell the provider the last time you had something to eat or drink.

In some cases, arm fracture ORIF is planned. Talk with your health care provider about how to get ready for your surgery. Tell him or her about all the medicines you take. This includes OTC medicines like ibuprofen. It also includes vitamins, herbs, and other supplements. You may need to stop taking some medicines before the procedure, such as blood thinners and aspirin. If you smoke, you may need to stop before your surgery. Smoking can delay healing. Talk with your health care provider if you need help to stop smoking.

Before your surgery, you may need imaging tests. These may include ultrasound, X-rays, or MRI.

Tell your health care provider if you:

  • Have had any recent changes in your health, such as an infection or fever

  • Are sensitive or allergic to any medicines, latex, tape, or anesthetic drugs (local and general)

  • Are pregnant or think you may be pregnant

Also, make sure to:

  • Ask a family member or friend to take you home from the hospital. You cannot drive yourself.

  • Don’t eat or drink after midnight the night before your surgery.

  • Follow all other instructions from your health care provider.

You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully. Ask questions if something is not clear.

You will also need to plan some changes at home to help you recover. You may need help at home.

On the day of surgery

Your surgeon will explain the details of your surgery. The preparation and surgery may take a couple of hours. In general, you can expect the following:

  • You will likely have general anesthesia. This will prevent pain and make you sleep through the surgery. Or you may have regional anesthesia to numb the area and medicine to help you relax and sleep through the surgery.

  • A health care provider watches your vital signs, like your heart rate and blood pressure, during the surgery.

  • After cleaning the skin, your surgeon makes a cut (incision) through the skin and muscles of your arm. Or with some fractures, the surgeon makes an incision on the top of the shoulder.

  • Your surgeon puts the pieces of your humerus back in place. This is the reduction.

  • Next, your surgeon uses special screws, plates, wires, or nails to hold the bone pieces together. This is the fixation. It helps the bone heals correctly.

  • Other repairs are made to the area as needed.

  • The layers of muscle and skin around your ankle and foot will be closed with stitches (sutures). 

After your surgery

Talk with your surgeon about what you can expect after your surgery. You may go home the same day. Or you may stay overnight in the hospital. Before leaving the hospital, you will have X-rays taken of your arm. This is to check the repair.

You might have some fluid draining from your incision. This is normal. You will have some pain after the surgery. Your doctor will tell you what pain medicine you can take to help reduce the pain. Avoid certain OTC medicines for pain as instructed. Some of these may interfere with bone healing. You can also use ice packs to help lessen pain and swelling.

You may be told to not move your arm for a while after your surgery. You may need to wear a splint for several weeks. You will get instructions about when and how you can move your arm. Your surgeon may also tell you to eat foods high in calcium and vitamin D to help with bone healing.

Follow-up care

Make sure to keep all of your follow-up appointments. You may need to have your stitches removed a week or so after your surgery.

You may have physical therapy to improve the strength and movement of your arm. The therapy may include treatments and exercises. The therapy improves your chances of a full recovery. Most people are able to return to all their normal activities within a few months.


When to call your health care provider

Call your health care provider right away if you have any of these:

  • Fever of 100.4°F (38°C) or higher

  • Redness, swelling, or fluid leaking from your incision that gets worse

  • Pain that gets worse

  • Loss of feeling in your arm or hand