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What is Open Reduction and Internal Fixation of the Foot?

Open reduction and internal fixation (ORIF) of the foot is a surgical procedure performed to repair serious fractures (broken bones) of the foot that cannot be fixed with a splint or a cast.

Open reduction refers to making an open incision (long surgical cut) to reach the broken bones and reposition or realign them back into their normal position. Internal fixation refers to utilizing fixation devices such as metal plates, screws, or rods to stabilize and hold the broken bones in place together while they heal.

The main objective of the ORIF of the foot is to correct the damaged structures of the foot to help reduce pain and restore mobility/natural function of the foot that has been lost due to injury or illness.

Anatomy of the Foot

The foot has 26 bones and can be divided into 3 parts: The hindfoot, midfoot, and forefoot. Muscles, tendons, and ligaments support the bones and joints of the feet, enabling them to withstand the entire body’s weight while walking, running, and jumping. The feet are susceptible to damage or fractures in the form of sports injuries, motor vehicle accidents, and work-related trauma that may harm the feet and cause significant pain and discomfort.

Indications for Open Reduction and Internal Fixation of the Foot

Open reduction and internal fixation of the foot are indicated for the correction of foot fractures that cannot be repaired properly with a splint or cast alone or with other treatment modalities. Your surgeon may recommend ORIF of the foot for the following conditions:

  • The fractured bone is shattered into many pieces
  • The fractured bone is protruding out of the skin
  • The fractured bone is not aligned or lined up properly
  • A dislocated joint
  • A closed reduction performed earlier failed to provide a satisfactory result. Closed reduction (CR) is manipulating and fixing the fracture fragments or dislocations into alignment externally without surgery.

Preparation for Open Reduction and Internal Fixation of the Foot

In general, preoperative preparation for open reduction and internal fixation of the foot will involve the following steps:

  • A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could threaten the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You should refrain from supplements or medications such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
  • You should refrain from alcohol or tobacco at least a week before surgery.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • Arrange for someone to drive you home after surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Open Reduction and Internal Fixation of the Foot

In general, open reduction and internal fixation of the foot surgery will involve the following steps:

  • You will be placed on the operating table in a specific position as per the treatment site under spinal or general anesthesia.
  • An incision is made over the skin above the fractured site to access the treatment area.
  • The underlying muscles are carefully separated to expose the broken foot bones.
  • Your surgeon will realign the bones into their correct position and fixation devices such as screws and other hardware are used to hold the bones in position and stabilize them while it heals. An x-ray may be ordered after attachment with the devices to confirm the corrective surgery.
  • The overlying soft tissue and skin are closed with sutures and sterile bandages are applied.
  • A splint or a cast will be placed on the treatment area in order to protect the repair and facilitate healing.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after open reduction and internal fixation of the foot will involve the following steps:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
  • You may notice some pain, swelling, and discomfort in the foot area. Pain and anti-inflammatory medications are provided as needed.
  • Antibiotics are also prescribed to address the risk of surgery-related infection.
  • Apply ice bags over a towel to the affected area for about 15-20 minutes to reduce postoperative pain and swelling.
  • Do not weight-bear on the operated leg. A walking boot or a non-weight-bearing cast is recommended for few weeks to facilitate healing and support the foot.
  • Keep the foot elevated at or above the level of your heart to help minimize swelling and discomfort.
  • Assistive devices such as crutches and walkers are recommended to maintain balance and stability while walking for many weeks.
  • At least 6 to 8 weeks may be required for the foot bones to fuse adequately for you to start weight-bearing on the operated leg.
  • Start rehabilitation (physical therapy) as recommended by your surgeon after a specified period of time to improve range of motion. You should begin appropriate exercises to stretch and strengthen the foot muscles.
  • Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
  • Full recovery from ORIF of the foot will usually take about 3 to 12 months. Refrain from strenuous activities and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
  • Return to sports is recommended only when the foot has regained its normal strength and function and with your doctor’s approval.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Open reduction and internal fixation of the foot is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

  • Infection
  • Bleeding
  • Pain
  • Swelling
  • Damage to nerves and vessels
  • Tendon or muscle damage
  • Blood clots
  • Irritation to hardware
  • Allergic reactions to anesthesia
  • Non-union of bones
  • Hardware failure
  • The Arthroscopy Association of North America
  • The American Osteopathic Academy of Orthopedics (AOAO)
  • The American Academy of Orthopaedic Surgeons
  • American Orthopaedic Foot & Ankle Society┬«
    Orthopaedic Foot & Ankle Foundation
  • American Academy of Osteopathy
  • American Osteopathic Association