What Is ORIF Surgery?

Written by Bethany Afshar
Medically Reviewed by Shruthi N, MD on June 15, 2025
5 min read

Open reduction and internal fixation (ORIF) is a type of surgery used to repair broken bones that need to be put back together. During the surgery, some form of hardware is used to hold the bone in place so it can heal.

ORIF surgery is needed only for severe fractures. It's often done as emergency surgery. If your bone is in pieces, it may need to be repositioned and held in place with screws or plates until it heals. This surgery is done by an orthopedic surgeon, a doctor with specialized training in treating bone, joint, and muscle problems.

What is the difference between closed and open reduction surgeries?

While an open reduction is performed surgically by an orthopedic surgeon, a closed reduction involves your doctor moving your bones back into place without needing to make an incision.

During the surgery, your bone fragments will be repositioned into normal alignment. The bone fragments are held together with hardware such as plates, screws, or wires. The implants are made from stainless steel or titanium because these are strong and durable metals. Here's a look at the types of hardware used for ORIF surgery.

Screws. Theyare the most common type of hardware used in ORIF surgery. The types of screws used to repair the bone depend on the kind of fracture you have, the size of the bone in question, and where the screws will be placed. They can be used alone or with other types of hardware. Once your fracture is healed, the screws may be left inside of you or removed.

Plates. Plates are like internal splints that hold your bone in place. Your doctor will use screws to attach the plates to your bones. After you've healed, the plates may be removed or left in place.

Rods or nails. If you've fractured a long bone, your doctor may use a rod or nail inserted through the center of your bone to hold it in place. Screws at each end of the rod hold it in place and keep the bones from rotating or shifting. This type of treatment is commonly used for fractures of the thigh bone or shin bone. Once your fracture has healed, the rods or nails can be removed or left in place.

Pins or wires. If your bone breaks into small pieces, your doctor may use wires to pin it back together. Wires and pins are often used with other types of internal fixation, but they can also be used alone. Sometimes, they're the only fixation used to fix small bones, such as those in the hands.

Wires are usually removed after your fracture heals. However, sometimes they're left in place.

External fixators. An external fixator can be used as a temporary frame to hold the bones together when the skin and muscle have been injured. With an external fixator, metal pins or screws are placed into the bone through small incisions in the skin and muscle. The pins or screws are attached to a bar on the outside of the skin.

An external fixator is often used as a temporary treatment when you have multiple injuries but aren't stable or healthy enough for surgery. In some cases, an external fixator may remain in place until your fracture is completely healed.

All surgeries have risks of complications. Some complications that can develop after ORIF surgery include: 

Complete recovery from ORIF surgery can take anywhere from 3 to 12 months, depending on which bone you broke and how severe the break was. You may need physical therapy after your surgery to help you regain full use of your limb. Here are some tips for taking care of yourself at home once your surgery is completed.

Elevate your injured limb. For the first 48 hours, try to keep your limb raised above the level of your heart. You may also use ice packs to reduce the swelling.

Try to stay on top of your pain. Your doctor will give you instructions about pain medicine. Make sure you have it before you go home and use it as instructed. If pain medicine doesn't ease your pain, call your doctor.

Cover your incision and keep it clean. Follow your doctor's instructions about showering and changing your bandages.

Don't put any pressure on your injured limb. Use crutches, a wheelchair, or a sling if your doctor sent you home with them. In the beginning, it's important not to use your injured limb even to balance or reposition yourself. Your doctor will give you instructions about when and how to start using your limb again.

Are ORIF screws permanent?

The hardware used in ORIF surgery typically stays in place permanently. The metal pieces will continue to support your bone even after it heals. Depending on the bone that is treated, there may be instances when a follow-up surgery is needed to remove the hardware. Talk to your surgeon about what you should expect.

Open reduction and internal fixation (ORIF) is a type of surgery used to fix severe fractures by realigning broken bones and securing them with hardware such as screws, plates, or rods. This surgery is typically performed by an orthopedic surgeon in emergency situations when bones are shattered or misaligned. Recovery can take anywhere from 3 to 12 months, and patients may need physical therapy to regain full use of their limb. It's important to follow post-surgery care instructions, such as keeping the limb raised above your heart level, managing pain, and avoiding pressure on the injured area.

How painful is internal fixation surgery?

You can expect to feel pain for the first few weeks after surgery, both from the surgery itself and as your bones begin to heal. Following your surgery, your doctor will recommend a pain management regimen that includes both prescription and over-the-counter pain medications.

Which condition would most probably require an ORIF?

Not every broken bone will require ORIF surgery, but you are more likely to need it if you have certain types of fractures, such as when the bone has broken through the skin (compound fracture), the bone is broken in more than one place (comminuted fracture), or pieces of the bone have moved enough to create a gap (displaced fracture). 

Do you need a cast after ORIF surgery?

It depends on the bone that's been broken, but often some sort of cast or splint is necessary to keep the broken bone immobilized while it heals. You may be required to wear a cast, splint, or walking boot for a few weeks. Your doctor will tell you what you can expect after surgery.