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Open Reduction and Internal Fixation for Ankle Fractures

Ankle fractures can cause swelling, instability, and severe pain that makes it difficult to walk or bear weight. When the bones of the ankle are severely misaligned or broken, Open Reduction and Internal Fixation (ORIF) is commonly used.

At the Orthopedic Foot & Ankle Center in Greater Columbus, we provide surgical repair for complex ankle fractures. If you need the ORIF procedure, contact us to schedule an appointment.

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Topic at a Glance

  • Open Reduction and Internal Fixation (ORIF) is a surgical procedure used to treat complex or displaced ankle fractures.
  • During ORIF, the broken bones are realigned and stabilized with hardware such as screws, plates, or rods.
  • ORIF may be recommended for severe fractures, open fractures, ankle dislocations, or injuries that did not heal properly with non-surgical treatment.
  • Recovery includes immobilization, physical therapy, gradual weight-bearing, and follow-up care to restore strength and mobility.

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Do I Need Surgery?

Visiting an orthopedic surgeon doesn’t mean that surgery is necessary. Our orthopedic doctors always prefer to use non-surgical procedures to treat injuries.

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What is an Ankle Fracture Open Reduction and Internal Fixation?

Ankle fractures occur when one or more bones in the ankle joint break. The three bones that make up the ankle include the lower tibia (the larger bone of the lower leg), the lower fibula (the smaller bone), or talus (top of the foot).

Fractures can involve a simple crack in the bone or multiple breaks where the bones are displaced or punctured through the skin. While many ankle fractures can heal with conservative care, more complex injuries may require surgery.

Open Reduction and Internal Fixation (ORIF) is a surgical method used for treating bone fractures that are displaced or involve multiple fractures. The procedure is divided into the following two parts:

  • Open Reduction: The surgeon repositions the broken bones in their correct alignment through open surgery.
  • Internal Fixation: Internal fixation refers to the hardware that is used to hold the bone pieces in position. They provide stability to the ankle joint as the bones heal properly. The hardware may include screws, plates, or rods.

What Are the Reasons for ORIF?

There are various reasons why an orthopedic surgeon might recommend ORIF for an ankle fracture. ORIF procedure may be recommended in the following situations:

  • Displaced Fractures: If the bones broke and are not in proper alignment, they may not heal correctly on their own. This can lead to long-term complications such as arthritis or chronic pain.
  • Open Fractures: When broken bones have pierced through the skin, there is a higher risk for infection. Surgical intervention is required to clean the wound and stabilize the bone.
  • Multiple Fractures: In cases where there are multiple breaks in the ankle bones, ORIF may be the best option to ensure the bones are properly aligned and stabilized for healing.
  • Failed Non-Surgical Treatment: If non-surgical treatments such as casting or bracing have not helped the bones heal properly, ORIF may be necessary to correct the alignment.
  • Ankle Dislocation: Sometimes, ankle fractures are accompanied by a dislocation of the ankle joint. ORIF helps realign the joint and stabilize the bones simultaneously.
A doctor examining a patient after open reduction and internal fixation to treat an ankle fracture in Columbus, Ohio.

What Are the Risks and Benefits of ORIF?

Like any surgical procedure, ORIF carries both risks and benefits that should be carefully considered.

Benefits of ORIF

Some of the benefits of ORIF include the following:

Risks of ORIF

Some of the risks associated with ORIF include the following:

Preparing for the ORIF Procedure

Preparation for ORIF surgery involves several steps to ensure the best possible outcome. Patients should:

  • Undergo Pre-Surgical Evaluations: Your surgeon may order X-rays, CT scans, or MRIs to get a detailed view of the fracture and plan the surgery.
  • Discuss Medical History: It’s essential to inform your surgeon about any underlying medical conditions, allergies, or medications you are taking, including over-the-counter medicines, blood thinners, or supplements.
  • Follow Fasting Instructions: You’ll likely be instructed not to eat or drink anything after midnight on the day of your surgery to reduce the risk of complications from anesthesia.
  • Arrange for Post-Surgery Care: Make arrangements for someone to drive you home after the procedure and help with daily tasks as you begin your recovery.

What to Expect During ORIF Surgery

The ORIF procedure for ankle fractures is typically performed under general anesthesia, meaning you’ll be asleep during the surgery. Alternatively, you may have a local anesthesia and a medication to help you relax. Your surgery team will watch your blood pressure and other vital signs throughout the procedure. Here’s what happens during the procedure:

  1. Incision: The surgeon makes an incision near the fracture site to access the broken ankle bones.
  2. Open Reduction: The surgeon carefully realigns the bones to their proper position.
  3. Internal Fixation: Once the bone pieces are aligned, the surgeon secures them using screws, plates, or rods. These devices are typically made of stainless steel or titanium and are designed to remain in the body unless they cause complications.
  4. Closing the Incision: After the bones are stabilized, the incision is closed with sutures or staples, and a sterile dressing is applied.

 The duration of the surgery can vary depending on the complexity of the fracture but typically lasts a few hours.

Recovery After ORIF

Recovery following ORIF surgery is a gradual process that requires patience and adherence to your surgeon’s instructions. Here’s what you can expect:

Immediate Post-Surgery Care

Most patients stay in the hospital for one to two days after surgery. During this time, your surgical team will monitor your progress and manage your pain with medicines. Your ankle may be placed in a cast or splint to keep it immobilized and protected during the initial healing phase.

Home Recovery

When you arrive home, you will want to keep your ankle elevated as much as possible. This can help reduce swelling and pain and prevent blood clots. Pain medicines will be prescribed to manage any discomfort. You should follow the schedule to make sure you stay on top of the pain rather than waiting for the pain to come back before taking them.

As your bones start to heal, you will begin physical therapy. This is an important part of your recovery as it will prepare you for your return to activity. Exercises will be given to restore strength, flexibility, and range of motion in the ankle joint.

Your surgeon will advise you when it’s safe to start bearing weight on the ankle. This process is typically gradual, starting with partial weight-bearing and progressing to full weight-bearing as the bones heal.

Long-Term Recovery

You will need to have regular follow-up appointments with your surgeon to make sure the bones are healing properly.

It can take six to twelve months to heal completely from ORIF surgery. Most patients are able to return to normal activities and sports following completion of the treatment.

Getting Back on Your Feet with Expert Care

Open Reduction and Internal Fixation is a proven method for treating complex ankle fractures, offering patients the best chance for a full recovery and a return to normal activities.

If you or a loved one has experienced an ankle fracture and is considering ORIF, our experienced team at Orthopedic Foot & Ankle Center in Columbus, Ohio, is here to provide expert care and guidance through every step of the process. Schedule an appointment today to learn more about your treatment options and start your journey to recovery!

Medically reviewed by Roberto A. Brandão, DPM, FACFAS

FAQs About ORIF for Ankle Fractures

ORIF stands for Open Reduction and Internal Fixation. It is a surgical procedure used to realign broken ankle bones and secure them with metal hardware to promote proper healing.

ORIF may be recommended for displaced fractures, open fractures, multiple fractures, ankle dislocations, or fractures that have not healed correctly with casting or bracing.

Recovery varies depending on the severity of the fracture, but complete healing may take between 6 and 12 months. Physical therapy is often part of the recovery process.

Potential risks include infection, blood clots, nerve damage, delayed bone healing, or irritation from the surgical hardware.

Yes. Physical therapy is commonly recommended after surgery to help restore ankle strength, flexibility, range of motion, and walking ability.

Our Sports Medicine Specialist​s​

TERRENCE M. PHILBIN, DO

Board Certified Orthopedic Surgeon

MARK A. PRISSEL, DPM

Board Certified, Fellowship Trained Foot & Ankle Surgeon

RANDALL C. THOMAS JR., DPM

Board Certified Foot & Ankle Surgeon

COREY J. GRIFFITH, DPM

Board Certified Foot & Ankle Surgeon
Dr. Robert Brandao

ROBERTO A. BRANDÃO, DPM

Board Certified, Fellowship Trained Foot & Ankle Surgeon
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