What is elbow fracture open reduction and internal fixation?

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 elbow.

The elbow joint is a hinge type of joint composed of three bones. The humerus (the upper arm bone) forms the joint with two bones of the forearm: the radius and the ulna. The ulna forms the bony point of the elbow.

Different kinds of injury can damage any of the three bones that form the elbow joint. This is especially common when you fall on an outstretched hand. The bone may fracture into two or more pieces. In certain types of elbow fractures, your bone has broken, but its pieces still line up correctly. In other types of fractures (displaced fractures), the injury moves the bone fragments out of alignment.

If you fracture your elbow, you might need ORIF to bring your bones back into place and help them heal. During an open reduction, orthopedic surgeons reposition your bone pieces during surgery so that they are back in the right 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 might be done with special screws, plates, wires, or nails that the surgeon places inside the bones to fix them in the correct place. This prevents the bones from healing abnormally. The surgery usually takes place while you are asleep under general anesthesia.

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

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

Not everyone with a fractured elbow needs open reduction and internal fixation. In fact, most people don’t. If possible, your healthcare provider will treat your elbow fracture with more conservative 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 conservative treatments. You are likely to need ORIF if:

• The pieces of your broken bone are severely out of position

• Your broken bone pierced through your skin

• Your bone broke into several pieces

In these cases, ORIF can place 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 in your elbow joint, including the lower part of your humerus and the upper parts of your radius or ulna.

What are the risks of an elbow fracture open reduction and internal fixation?

Most people do very well with ORIF for their elbow fracture. Although rare, complications can occur. Possible complications include:

• Infection

• Bleeding

• Nerve damage

• Joint stiffness (common)

• Joint instability

• Bone misalignment or failure to heal

• Complications from anesthesia

• Broken screws or plates

• Arthritis of the joint (months to years later)

There is also a 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, the anatomy of your elbow fracture, and your other medical conditions. For example, people with low bone mass or diabetes may be at greater risk for certain complications. Smokers may also have an increased risk. Ask your healthcare provider about the risks that most apply to you.

How do I get ready for an elbow 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 need an image of your elbow. This is done with an X-ray, CT scan, or MRI. Tell your healthcare provider about all the medicines you take, including over-the-counter ones like aspirin. Also, let your healthcare provider know the last time you ate.

In some cases, your healthcare providers might do your ORIF a little later. If so, talk to your healthcare providers about how to prepare for the procedure. Ask whether you should stop taking any medicines ahead of time, such as blood thinners. You’ll need to not eat or drink after midnight the night before your procedure.

What happens during an elbow 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 severity of your injury. An orthopedic surgeon and a team of specialized healthcare providers will do the surgery. The surgery may take a couple of hours. In general, here's what you can expect:

• You will receive general anesthesia so that you’ll sleep through the surgery and won’t feel any pain or discomfort during the procedure. (Or, you may receive a local anesthesia and a medicine to help you relax.)

• An anesthesiologist 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 elbow. (The site may vary according to the bone injured.)

• Your surgeon will bring the pieces of your fractured bone or bones back into alignment ( reduction).

• Next, your surgeon will secure the pieces of the broken bone to each other ( fixation). To do this, they may use screws, metal plates, wires, or pins. (Ask what the surgeon will use in your case.)

• Your surgeon will make any other necessary repairs.

• After the surgeon has secured the bone, your surgeon will surgically close the layers of skin and muscle around your elbow.

What happens after an elbow fracture open reduction and internal fixation?

Talk to your surgeon about what you can expect after your surgery. You may have some pain after your procedure, but pain medicine may help. You should be able to go back to a normal diet quickly. You will likely get an imaging test done, like an X-ray, to make sure the surgery was successful. Depending on the extent of your injury and your other health conditions, you might be able to go home the same day.

For a while after your surgery, you’ll need to keep the arm immobile. Often, this means you'll need to wear a splint for several weeks. Make sure to protect your splint from water. You’ll receive instructions about how you can move your arm.

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

You might see 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 a 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 physical therapy to restore strength and flexibility to your muscles. Doing your exercises as prescribed can improve your recovery. Most people are able to return to most of their normal activities within a few months.

Next steps

Before you agree to the test or the 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