Some fractures are more complicated than others. Princeton Orthopaedic Associates can often set a clean fracture with external reduction, which is when the doctor moves the bones back into place so they can heal properly. But some breaks result in bone fragments, bones moved out of place, bones broken, and tendons or ligaments damaged. 

In these extreme cases, open reduction internal fixation (ORIF) surgery is necessary to ensure the bones heal correctly. This procedure is commonly used to treat wrist, forearm, and hand fractures. 

ORIF Procedure

During open reduction internal fixation, an incision is made to access the bones and bone fragments, put back together, and set in their proper place. Screws, rods, or plates may hold the bones and fragments in place, usually below the skin. In the most severe cases, rods will run from inside to outside the skin and attach to a brace to further immobilize the bone. 

The surgical hardware placed inside the skin is usually left permanently, barring any complications such as infection. External rods and braces will be removed once the bone has healed enough to remain stable without them. 

Recovery can take several weeks to a few months, and often physical therapy is needed afterward to return full mobility to the limb.