Hip fractures are common injuries, particularly in older adults or those who have experienced trauma. Open Reduction and Internal Fixation (ORIF) is a surgical procedure used to treat these fractures by stabilising the bone and allowing it to heal. This article explains what ORIF involves, its suitability for specific patients, and what to expect during recovery.
What Is Surgical Fixation (ORIF) for Hip Fractures?
Open Reduction and Internal Fixation (ORIF) is a surgical technique used to stabilise broken bones in the hip. It involves realigning the fractured bone and securing it with hardware to promote healing.
Open Reduction: This step involves surgically exposing the fracture and repositioning the bone fragments to their correct alignment. Proper alignment ensures the bone heals correctly and restores its function.
Internal Fixation: Metal hardware, such as screws, plates, or rods, is used to stabilise the bone and hold it in place during healing. These materials provide structural support and prevent movement at the fracture site.
Benefits of ORIF: By stabilising the fracture, pain is reduced and ORIF allows earlier mobilisation, reduces the risk of improper healing, and preserves the natural hip joint, which can lead to more natural movement after recovery.
Types of Fractures Treated: ORIF is used for fractures such as femoral neck and intertrochanteric fractures that are unstable or displaced. These fractures require surgical intervention because they cannot heal effectively with non-surgical methods.
When Is ORIF Recommended for Hip Fractures?
ORIF is typically recommended for specific cases, which may include:
Fractures Requiring Stabilisation: ORIF is used for fractures that are severely displaced or unstable, as these cannot heal properly without surgical intervention. Stabilising the bone helps prevent deformities or loss of function.
Younger, Active Individuals: Patients who are physically active or want to retain full hip joint mobility may benefit from ORIF. The procedure preserves the natural hip joint, making it suitable for younger or more active patients.
Limitations of ORIF: Patients with severe osteoporosis or health conditions that increase surgical risks may not be suitable for ORIF. In these cases, an experienced orthopaedic surgeon in Singapore evaluates alternative treatments based on the patient’s overall condition.
Preparing for Surgery
Preparation before surgery ensures that the procedure and recovery are managed effectively.
Medical Assessment
A medical assessment is carried out to evaluate the patient’s overall health and suitability for surgery. This includes reviewing the patient’s medical history to identify conditions such as diabetes or heart disease that may affect the procedure. Tests such as blood work, ECGs, and other evaluations help detect potential risks that may need to be addressed before surgery.
Imaging Studies
X-rays or CT scans, are used to determine the type, location, and severity of the fracture. X-rays provide an overview of bone displacement, while CT scans may be used for more detailed imaging of complex fractures. These studies help the surgeon plan the surgical approach and select the hardware needed for stabilisation.
Pre-Operative Instructions
Patients are instructed to fast for a specified period before surgery and may need to stop or adjust medications like blood thinners. These measures reduce risks during surgery and anaesthesia.
Step-By-Step Procedure
ORIF involves several steps to reposition and stabilise the fractured hip bone. The key steps include:
Anaesthesia Administration
The procedure is performed under general anaesthesia (patient is unconscious) or spinal anaesthesia (lower body is numbed). The choice depends on the patient’s condition and the surgeon’s recommendation.
Making the Incision
An incision is made near the hip to access the fractured bone. The size and location of the incision depend on the type and severity of the fracture, with care taken to minimise disruption to surrounding tissues.
Bone Realignment (Open Reduction)
The surgeon repositions the bone fragments into their correct alignment to ensure the fracture heals properly. This prevents deformities and restores structural integrity.
Securing the Fracture (Internal Fixation)
Metal hardware, including screws, plates, or rods, is used to stabilise the fractured bone and maintain its alignment. This hardware prevents movement at the fracture site, allowing the bone to heal properly and withstand weight-bearing forces as the patient gradually resumes activity.
Testing and Closure
The surgeon tests the stability of the fixation by gently moving the joint. The incision is then closed using sutures or staples, and a sterile dressing is applied.
Recovery After ORIF for Hip Fractures
Recovery includes hospital care, rehabilitation, and follow-up appointments to monitor healing.
Early Recovery with Immediate Ambulation and Weight-Bearing
Patients usually stay in the hospital for 1–3 days for pain management and wound care. Early mobilisation is encouraged using assistive devices like walkers or crutches to minimise stress on the hip.
Rehabilitation
Physical therapy begins soon after surgery to restore joint mobility and strength. Rehabilitation progresses gradually, from partial weight-bearing to full mobility, as advised by the surgeon.
Follow-Up Care
Regular follow-up appointments are scheduled to monitor healing and ensure the hardware remains stable. Adjustments to therapy or additional imaging may be recommended if necessary.
Potential Risks and Complications
This procedure is common, but it carries some risks. These include infection, blood clots, and nerve or vascular injury. Specific complications can include hardware failure, malunion, or nonunion of the fracture, which may require further intervention. Patients should watch for signs such as redness, swelling, or persistent pain and contact their healthcare provider if these occur.
Conclusion
ORIF for hip fractures is a reliable treatment for stabilising fractures, restoring alignment, and preserving mobility. With thorough preparation, effective surgery, and adherence to rehabilitation plans, many patients regain function and return to daily activities.
If you suspect a hip fracture, contact Dr Wang Lushun, a leading hip specialist Singapore, today to schedule a consultation and discuss your treatment options.
