At a glance
Fracture fixation (ORIF) is a surgical procedure in which a broken bone is surgically opened, set back into its correct position, and held there with metal hardware until it heals.
ORIF stands for Open Reduction and Internal Fixation. 'Open reduction' means the surgeon makes a cut through the skin to reach the broken bone and manually lines up the fragments. 'Internal fixation' means metal plates, screws, rods, or pins are attached directly to the bone to keep everything stable while new bone tissue grows across the fracture line.
Medical Condition
ORIF is used when a broken bone cannot be safely held in place by a cast or splint alone, usually because the fracture is too complex or the bone fragments have shifted out of alignment.
- Displaced fractures, where bone fragments have moved out of their normal position
- Comminuted fractures, where the bone has shattered into multiple pieces
- Intra-articular fractures, where the break extends into a joint such as the knee, ankle, wrist, or hip
- Open fractures, where the broken bone has pierced through the skin
- Fractures that failed to heal correctly after a previous attempt at treatment
- Fractures in the hip, femur (thigh bone), tibia (shin bone), forearm, or ankle that are unstable
- Fractures in patients whose daily movement cannot wait for slow non-surgical healing, such as elderly patients with hip fractures
ORIF is generally not suitable in certain situations, and your surgeon will weigh these carefully before recommending it.
- Active infection at or near the fracture site, which raises the risk of spreading infection to the implant
- Very poor bone quality that cannot hold screws or plates securely
- Serious blood-clotting disorders that cannot be managed before surgery
- Patients whose overall health makes general or regional anaesthesia too dangerous
- Fractures that are stable and well-aligned, where non-surgical treatment is equally effective
Risks & Complications
Like any surgery involving metal implants and bone, ORIF carries recognised risks that your surgeon will discuss with you before you consent to the procedure.
- Infection, either at the skin incision or deeper around the implant, sometimes requiring further surgery or removal of the hardware
- Bleeding during or after the operation, occasionally requiring a blood transfusion
- Deep vein thrombosis (DVT), a blood clot that forms in the leg veins, which can travel to the lungs
- Anaesthesia-related reactions, including nausea, allergic responses, or breathing difficulties
- Delayed bone healing or non-union, where the fracture does not fully knit together despite the hardware
- Malunion, where the bone heals in a slightly incorrect position, potentially affecting movement
- Nerve or blood vessel injury near the fracture site, which may cause numbness, weakness, or circulation problems
- Hardware failure, such as a screw or plate breaking or loosening before the bone has fully healed
- Scarring and stiffness of the surrounding soft tissue, which can limit range of motion
- Need for a second surgery to remove the hardware once healing is complete, if the implant causes irritation
Preparation & Procedure
Preparation for ORIF begins several days before the surgery and covers your diet, your medications, and some lifestyle adjustments.
You will usually be asked to stop eating solid food at least six hours before the operation, and to stop drinking clear fluids at least two hours before. Smoking slows bone healing and raises the risk of infection, so your surgical team will ask you to stop as early as possible before the procedure. Alcohol is also avoided in the days leading up to surgery, as it can interact with anaesthesia and affect blood clotting.
Several medications are typically paused before surgery. Blood thinners (anticoagulants) are usually stopped several days in advance to reduce bleeding risk. Certain anti-inflammatory painkillers and supplements such as fish oil or vitamin E may also be paused. Your doctor will give specific guidance based on all the medications you currently take.
Before the operation, your care team will usually run a set of pre-operative tests. These commonly include blood tests to check your general health and clotting ability, an X-ray or CT scan (computed tomography, a detailed cross-sectional imaging test) of the injured bone to plan the exact approach, an electrocardiogram (EKG, a heart tracing) if you are older or have a heart condition, and a chest X-ray to check your lungs.
On the day of surgery, the procedure itself generally follows these steps.
- You change into a surgical gown and a nurse confirms your identity, the injury site, and your allergy history.
- An intravenous (IV) line is placed in your arm so fluids and medications can be given directly into your bloodstream.
- The anaesthesia team administers general anaesthesia (which puts you fully to sleep) or regional anaesthesia (which numbs only the affected limb), depending on the fracture location and your health.
- The surgeon makes an incision (cut) through the skin and underlying tissue to expose the broken bone.
- The bone fragments are carefully moved back into their correct anatomical position. This step is called 'reduction'.
- Metal plates, screws, intramedullary rods (rods placed inside the bone canal), or wires are fixed to the bone to hold the reduced position. The choice of hardware depends on the bone and fracture type.
- The surgeon checks the alignment, usually with an intraoperative X-ray (an X-ray taken during the operation), before closing.
- The incision is closed in layers using stitches or staples, and a sterile dressing is applied. A splint or cast may be placed over the limb.
Aftercare
Recovery after ORIF varies depending on which bone was fixed, the complexity of the fracture, and your overall health, but there are common steps that apply to most patients.
- You will spend time in a recovery room immediately after surgery while the anaesthesia wears off, then usually move to a general ward. Some complex cases require a night or more in hospital.
- Pain is managed with prescribed painkillers. Swelling and discomfort in the first few days are expected and are controlled with elevation of the limb and ice packs where appropriate.
- Blood thinners are often prescribed for several weeks after surgery to reduce the risk of DVT.
- The wound dressing is checked and changed at regular intervals. Stitches or staples are usually removed within one to two weeks, depending on the location and your surgeon's protocol.
- Weight-bearing on the operated limb is restricted at first. Your surgeon will specify when and how much weight you can put through the limb, which changes as healing progresses.
- Physiotherapy (guided movement exercises) starts early in many cases, sometimes within days of surgery, to prevent stiffness and rebuild muscle strength.
- Follow-up X-rays are taken at regular appointments, typically at several weeks and then several months after surgery, to confirm the bone is healing correctly.
- Most patients return to light daily activities within weeks, but full recovery, including return to sports or heavy work, can take several months.
- The metal hardware is usually left in place permanently. Removal is only considered if it causes pain or skin irritation, and is a separate elective procedure.
- Smoking should be avoided throughout the healing period, as it significantly slows bone repair.
Cost & What Determines It
The cost of ORIF varies widely because the procedure is not a single standard operation. It changes based on which bone is being fixed, how complex the fracture is, and where in the world the surgery takes place.
- Fracture complexity and location: a simple single-bone fracture costs significantly less than a shattered joint or a fracture requiring multiple implants
- Type and quantity of implants: titanium or stainless steel plates, screws, intramedullary rods, and wires are billed separately and vary in cost depending on size, material, and brand
- Hospital class: a private tertiary hospital charges more than a public or regional hospital, and costs differ substantially between countries
- Length of stay: a straightforward case may require one or two nights in hospital, while a complex fracture or complication can mean a week or longer
- Operating room and anaesthesia fees: longer or more technically demanding surgeries require more resources and time in theatre
- Pre-operative investigations: the set of blood tests, X-rays, CT scans, and cardiology tests required before surgery are usually billed separately
- Post-operative physiotherapy: rehabilitation sessions add to the overall cost, especially if inpatient physiotherapy is needed
- Medication: blood thinners, antibiotics, and pain management drugs during the hospital stay contribute to the final bill
- A possible second surgery to remove the hardware in future, if needed, represents an additional cost not included in the initial procedure
Hospital packages for ORIF typically include the operating room fee, anaesthesia, the surgeon's fee, nursing care during the hospital stay, and a basic set of post-operative medications. Implant costs, pre-operative tests, physiotherapy sessions, follow-up outpatient visits, and any additional nights in hospital due to complications are commonly billed separately, so reviewing the package in detail before signing is sensible.
Indonesian patients travelling abroad for ORIF almost always pay out of pocket. BPJS Kesehatan does not cover treatment received outside Indonesia, and most Indonesian private health insurance policies also exclude overseas care unless a specific international rider has been added. Patients with international health insurance should verify their policy's coverage for elective orthopaedic surgery before booking. Requesting a written cost estimate, broken down by each item, from the hospital before travelling is the most reliable way to budget accurately and avoid unexpected bills on discharge.
Frequently Asked Questions
How long does ORIF surgery take?
Most ORIF procedures take between one and three hours, though complex fractures involving multiple bone fragments or a large joint can take longer. The exact duration depends on which bone is broken, how badly it is displaced, and the approach the surgeon chooses. Your surgical team will give you a more specific estimate once they have reviewed your scans.
Will I be put to sleep for fracture fixation surgery, and how bad is the pain afterwards?
Most patients receive either general anaesthesia (fully asleep) or regional anaesthesia (a nerve block that numbs only the operated limb), and the choice depends on the fracture location and your overall health. During surgery you will feel nothing. Afterwards, some pain and swelling around the repair site are normal, and the medical team typically manages this with pain relief medication for the first several days.
How long is recovery after ORIF, and when can I go back to work?
Recovery varies widely depending on which bone was fixed and the demands of your job. Most people with a desk job can return to work within a few weeks, while those doing physical labour often need three to six months before they are cleared for full activity. Bone healing itself usually takes six to twelve weeks, and physiotherapy (exercises guided by a therapist to restore strength and movement) is usually part of the recovery plan.
How much does fracture fixation (ORIF) surgery cost?
The cost depends on several factors specific to your case: which bone is being repaired, the complexity of the fracture, the type and number of implants used (such as metal plates, screws, or rods), the length of your hospital stay, and the class of room you choose. Because these variables differ from patient to patient, the most reliable way to get a real number is to request a written estimate directly from the hospital based on your X-rays or scans.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
