Femur Fracture Open Reduction and Internal Fixation

What is a femur fracture open reduction and internal fixation?

Open reduction and internal fixation (ORIF) is surgery used to stabilize and heal a broken bone. You might need this procedure to treat your broken thighbone (femur).

The femur is the large bone in the upper part of your leg. Different kinds of injury can damage this bone, causing it to fracture into two or more pieces. This might happen to the part of the femur near your knee, near the middle of the femur, or in the part of the femur that forms part of your hip joint. In certain types of femur fractures, your femur has broken, but its pieces still line up correctly. In other types of fractures (displaced fractures), the injury moves the bone fragments out of position.

If you fracture your femur, you usually need ORIF to bring your bones back into place and help them heal. The surgery is done by an orthopedic surgeon. This is a healthcare provider who specializes in treating bone, muscle, joint, and tendon problems. During the open reduction, the surgeon repositions your bone pieces so that they are back in their correct place. This is different from a closed reduction. For that procedure, a healthcare provider moves your bones back into place without surgically exposing your bone.

Internal fixation refers to the method of reconnecting your bones. This might be done with special screws, plates, rods, wires, or nails that your surgeon places inside your bones to fix them in the correct place. This prevents your bones from healing abnormally. For a fracture in the long, middle part of your femur, your surgeon may insert a long metal rod through the middle of your bone. The surgery usually takes place while you are asleep under general anesthesia.

Why might I need a femur fracture open reduction and internal fixation?

Certain health conditions may make breaking your femur more likely. For example, if you are an older adult, osteoporosis increases your risk of breaking your femur. Your femur might also be more likely to break if you have bone cancer. Motor vehicle accidents, sports-related injuries, gunshot injuries, and falls are common sources of injury that can lead to a femur fracture. A direct blow to your hip may break the part of the femur linked to your hip joint.

Most people with a fractured femur need some sort of surgery, usually ORIF. Without the surgery, your broken femur may not heal correctly. ORIF can place your bones back into the right position. This greatly increases the chance that your bone will heal normally. Your surgeon might advise treatment other than surgery for a very young child, or for people with other health conditions that make surgery more dangerous.

You might need ORIF for a fracture that occurs anywhere along your femur, including the portion that forms part of your hip joint. In a broken hip, it is actually part of your femur that breaks and not part of the hipbone itself.

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

Most people do very well after ORIF for their femur fracture. But sometimes complications can occur. Possible complications include:

• Infection
• Bleeding
• Nerve damage
• Blood clots
• Fat embolism
• Healing of the fractured bone out of position, or failure to heal
• Irritation of the overlying tissue from the hardware
• Complications from anesthesia

There is also a risk that the fracture won’t heal normally and that you’ll need repeat surgery.

Your risk for complications may vary according to your age, the anatomy of your femur fracture, and other health conditions. For example, people with low bone mass or diabetes may be at greater risk for some 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 a femur fracture open reduction and internal fixation?

ORIF often takes place as an urgent procedure. Before your procedure, a healthcare provider will ask about your health history and give you a physical exam. You’ll need imaging of your femur, probably with an X-ray or CT scan. Tell your healthcare provider about all the medicines you take, including over-the-counter medicines such as aspirin. Also, let them know the last time you ate.

In some cases, your healthcare provider might do your ORIF as a planned procedure. If so, you might need to have your leg placed in traction while you wait for surgery. Talk with your surgeon about how you can get ready for the surgery. Ask whether you should stop taking any medicines, such as blood thinners ahead of time.

Follow any directions you are given for not eating or drinking before the procedure.

What happens during a femur fracture open reduction and internal fixation?

Your surgeon can help explain the details of your surgery. These details 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 few hours. In general, you can expect the following:

• You will receive general anesthesia to make you sleep through the surgery so that you won’t feel any pain. Or you may receive 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 your skin and muscle of your thigh, hip, knee, or any combination.
• Your surgeon will bring the pieces of your femur back into position (reduction).
• Next, your surgeon will secure the pieces of your femur to each other (fixation). To do this, they may use screws, metal plates, wires, or pins. For a fracture in the middle part of your femur, surgeons often use a specially designed long metal rod that passes through the middle of the bone. It screws into the bone at both ends. (Ask what your surgeon will use in your case.)
• Your surgeon may make other repairs, if necessary.
• After the surgeon has secured your bone, the layers of skin and muscle around your thigh will be surgically closed.

What happens after a femur fracture open reduction and internal fixation?

Talk to your healthcare provider about what you can expect after your surgery. You may have a lot of pain after your procedure, but pain medicine may help. You should be able to resume your normal diet fairly quickly. You will probably have an imaging test, such as an X-ray, to make sure your surgery was successful. Depending on the extent of your injury and other health conditions, you might be able to go home within the next couple of days.

Talk with your surgeon about how you can move your leg and whether it’s OK to put weight on it. This will depend on the type of injury you have. Follow all your surgeon's instructions carefully. You might need to take blood thinner medicine to prevent blood clots for a while after your surgery. Your surgeon might not want you to take certain over-the-counter medicines for pain. Some of these can interfere with bone healing. Your surgeon may advise you to eat a diet high in calcium and vitamin D as your bone heals.

You might have some fluid draining from your incision. This is normal. Let your surgeon know right away if you see an increase in redness, swelling, or draining from your incision, a high fever, chills, or severe pain. Also, let them know about any loss of feeling in your leg.

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 chances for a full recovery. Most femoral fractures take about 4 to 6 months to heal completely, but you should be able to resume many activities before this time.

Next steps

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• The name of the test or procedure
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• What the possible side effects or complications are
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• 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
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