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What Is Orif Knee Surgery?

ORIF stands for open reduction internal fixation, a method of setting a broken bone. Open reduction means that surgeons open the muscles around the bone to view and set the fracture. Internal fixation means that surgeons use permanent metal screws, plates and/or nails to hold the bones together rigidly, from inside the body rather than from outside. ORIF knee surgery refers to the use of this technique for fractures of leg bones near or at the knee joint and for fractured kneecaps.

  1. ORIF for Fractures Near the Knee

    • Either the femur (thigh bone) or tibia (shin bone) or both can break near the knee, with the fractures usually treatable with ORIF. When the leg bones break just above and just below the knee joint, doctors call it "floating knee." According to an article on eMedicine by S. Vidyahara, this severe fracture occurs most often in males 20 to 30 years old. Automobile accidents, gunshot wounds and high falls represent the most common causes. The fracture(s) may also involve damage to blood vessels, ligaments and surrounding tissues.

    Work-up of the Patient

    • Images of the fracture guide the physicians in whether to use ORIF and in the choice of hardware. X-rays of each fracture and of the knee joint from both top and side views give the physician the best idea of the fracture. Magnetic resonance imaging (MRI) help identify damage to the ligaments, while computed tomography (CT) scanning lets the physician view the three-dimensional arrangement of the fracture fragments. Patient reports of pain, restricted movement or leg deformity add to the clinical presentation.

    ORIF of the Fractures

    • The exact nature of the fractures determines the specific locations of incisions and types of hardware. The goals of the surgical techniques employed include restoration of the joint line and leg motion. The surgeon makes an incision, pulls back the soft tissue and applies the hardware as necessary. Often, the surgeon will choose screws to hold the fracture together. Cannulated (hollow) screws permit drainage and/or insertion of wires. Rigidity can also come from the use of a plate across the line of the fracture, held in place by screws.

    Prognosis After ORIF Knee Surgery

    • The probability of a good to excellent outcome after ORIF surgery depends on the complexity and location of the fracture. Involvement of the knee joint, damage to surrounding soft tissues and greater time between injury and fixation of the fracture can all reduce the quality of the outcome and favor alternative techniques. In children, leg length may be affected if the area of the fracture and ORIF involves the physis, the part of the bone that lengthens during childhood growth.

    ORIF of the Patella

    • Fractures of the patella (kneecap) may also be treated with ORIF, according to information posted at eORIF.com. The same concept applies as above, using open surgery to place metal hardware to fixate the fracture of the patella. In the case of this small bone, surgeons use small cannulated screws and wires to hold the broken pieces of bone together.

    Further Considerations

    • As with all surgeries, ORIF may be complicated by infection, the use of anesthesia and postoperative pain during recuperation. Sometimes, the patient may need a follow-up procedure to improve bone grafting or correct undesirable outcomes, such as poor alignment of the joint or reactions to the hardware.

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