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Sonia Rufa Joy L.

Singson BSN III – B April 19, 2011

OPEN REDUCTION INTERNAL FIXATION


1. Description of operation:
- Open reduction internal fixation is a method of surgically repairing a fractured bone. Generally, this
involves either the use of plates and screws or an intramedullary (IM) rod to stabilize the bone. It
involves the implementation of implants to guide the healing process of a bone, as well as the open
reduction, or setting, of the bone itself. Open reduction refers to open surgery to set bones, as is
necessary for some fractures; internal fixation refers to fixation of screws and/or plates to enable or
facilitate healing.

2. Anatomy and Physiology:


Bone Structure
There are two kinds of bone tissue (see Figure 1 ):
- Compact bone is the hard material that makes up the shaft of long bones and the outside surfaces
of other bones. Compact bone consists of cylindrical units called osteons (Haversian systems). Each
osteon contains concentric lamellae (layers) of hard, calcified matrix with osteocytes (bone cells)
lodged in lacunae (spaces) between the lamellae. Smaller canals, or canaliculi, radiate outward from
a central canal (Haversian canal), which contains blood vessels and nerve fibers. Osteocytes within
an osteon are connected to each other and to the central canal by fine cellular extensions. Through
these cellular extensions, nutrients and wastes are exchanged between the osteocytes and the blood
vessels. Perforating canals (Volkmann's canals) provide channels that allow the bloo d vessels that
run through the central canals to connect to the blood vessels in the periosteum that surrounds the
bone.

Figure 1 Main features of a long bone.

- Spongy bone consists of thin, irregularly shaped plates called trabeculae, arranged in a latticework
network. Trabeculae are similar to osteons in that both have osteocytes in lacunae that lie between
calcified lamellae. As in osteons, canaliculi present in trabeculae provide connections between
osteocytes. However, since each trabecula is only a few cell layers think, each osteocyte is able to
exchange nutrients with nearby blood vessels. Thus, no central canal is necessary.
Here are the main features of a long bone (refer to Figure 1 ):
 The diaphysis, or shaft, is the long tubular portion of long bones. It is composed of compact bone tissue.
 The epiphysis (plural, epiphyses) is the expanded end of a long bone.
 The metaphysis is the area where the diaphysis meets the epiphysis. It includes the epiphyseal line, a remnant
of cartilage from growing bones.
Sonia Rufa Joy L. Singson BSN III – B April 19, 2011

 The medullary cavity, or marrow cavity, is the open area within the diaphysis. The adipose tissue inside the
cavity stores lipids and forms the yellow marrow.
 Articular cartilage covers the epiphysis where joints occur.
 The periosteum is the membrane covering the outside of the diaphysis (and epiphyses where articular cartilage
is absent). It contains osteoblasts (bone-forming cells), osteoclasts (bone-destroying cells), nerve fibers, and
blood and lymphatic vessels. Ligaments and tendons attach to the periosteum.
 The endosteum is the membrane that lines the marrow cavity.
Here are the main features of short, flat, and irregular bones:
 In short and irregular bones, spongy bone tissue is encircled by a thin layer of compact bone tissue.
 In flat bones, the spongy bone tissue is sandwiched between two layers of compact bone tissue. The spongy
bone tissue is called the diploe.
 Periosteum covers the outside layer of compact bone tissue.
 Endosteum covers the trabeculae that fill the inside of the bone.
 In certain bones (ribs, vertebrae, hip bones, sternum), the spaces between the trabeculae contain red marrow,
which is active in hematopoiesis.

Functions of Bones
Bone is often stereotyped as simply a protective and supportive framework for the body. Though it does perform
these functions, bone is actually a very dynamic organ that is constantly remodeling and changing shape to adapt to
the daily forces placed upon it. Moreover, bone stores crucial nutrients, minerals, and lipids and produces blood cells
that nourish the body and play a vital role in protecting the body against infection. All these functions make
approximately 206 bones of the human body an organ that is essential to your daily existence.
The skeletal system consists of bones, cartilage, and the membranes that line the bones. Each bone is an organ that
includes connective tissue (bone, blood, cartilage, adipose tissue, and fibrous connective tissue), nervous tissue, and
muscle and epithelial tissues (within the blood vessels).

Bones have many functions, including


 Support. Bones provide a framework for the attachment of muscles and other tissues.
 Protection. Bones such as the skull and rib cage protect internal organs from injury.
 Movement. Bones enable body movements by acting as levers and points of attachment for muscles.
 Mineral storage. Bones serve as a reservoir for calcium and phosphorus, essential minerals for various cellular
activities throughout the body.
 Blood cell production. The production of blood cells, or hematopoiesis, occurs in the red marrow found within
the cavities of certain bones.
 Energy storage. Lipids (fats) stored in adipose cells of the yellow marrow serve as an energy reservoir.

3. Medical Management: (post-op)


- Tell patient to keep a written list of the medicines you take, the amounts, and when and why it should
be taken. (Do not use any medicines, over-the-counter drugs, vitamins, herbs, or food supplements
without first talking to caregivers.)
- Antibiotics: This medicine is given to fight or prevent an infection caused by bacteria. Always take your
antibiotics exactly as ordered by your caregiver. Keep taking this medicine until it is completely gone,
even if you feel better. Stopping antibiotics without your caregiver's OK may make the medicine unable
to kill all of the germs. Never "save" antibiotics or take leftover antibiotics that were given to you for
another illness.
- Blood thinners: Blood thinners are medicines that help prevent clots from forming in the blood. Clots
can cause strokes, heart attacks, and death. Blood thinners may cause you to bleed or bruise more
easily. If you are taking a blood thinner:
 Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel
movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth.
Sonia Rufa Joy L. Singson BSN III – B April 19, 2011

Doing this can keep your skin and gums from bleeding. If you shave, use an electric
shaver. Do not play contact sports.
 Talk to your caregiver about all of the medicines that you use. You will need to have
regular blood tests while taking this medicine. Your caregiver uses these tests to decide
how much medicine is right for you to take. Take this medicine exactly how your caregiver
tells you to. Tell your caregiver right away if you forget to take the medicine, or if you
take too much.
 Talk to your caregiver about your diet. This medicine works best when you eat about the
same amount of Vitamin K every day. Vitamin K is found in green leafy vegetables and
certain other foods.
- Warfarin: Warfarin is a type of medicine that helps prevent clots from forming in the blood. Clots can
cause strokes, heart attacks, and death. Using warfarin may cause you to bleed or bruise more easily. If
you are taking warfarin, do the same as blood thinners.
- Acetaminophen: This medicine is used to decrease pain and lower a high body temperature (fever).
Talk to your caregiver before taking more than one medicine that contains acetaminophen. Ask your
caregiver before taking over-the-counter medicine if you are also taking pain medicine prescribed
(ordered) for you.
- Nonsteroidal anti-inflammatory medicine: This family of medicine is also called NSAIDs. It helps
decrease pain and inflammation (swelling). Some NSAIDs may also be used to decrease a high body
temperature (fever). This medicine can be bought with or without a doctor's order. This medicine can
cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow
the directions on it before using this medicine.
- Pain medicine: You may be given medicine to take at home to take away or decrease pain. Your
caregiver will tell you how much to take and how often to take it. Take the medicine exactly as directed
by your caregiver. Do not wait until the pain is too bad before taking your medicine. The medicine may
not work as well at controlling your pain if you wait too long to take it. Tell caregivers if the pain
medicine does not help, or if your pain comes back too soon.

4. Nursing Management:
- Preoperative
 Provide routine pre-op care.
 Provide meticulous skin preparation to prevent infection.
 If your surgery is scheduled, you may be asked to stop taking medicines that thin the blood, like
warfarin (Coumadin), clopidogrel (Plavix), or aspirin . If surgery is urgent, make sure to let your
doctor know if you take any blood-thinners or other medicines. This may cause bleeding while
doing surgery.
 Since broken bones are caused by trauma or an accident, an ORIF surgery is typically an
emergency procedure. Before your surgery, you may have:
 Questions you should ask include: Will I need rehabilitation after surgery? What will I need
to assist in my recovery (eg, wheelchair , crutches )?
 Blood tests
 Physical exam to check your blood circulation and nerves affected by the broken bone.
 Questions your doctor may ask include: How did you break your bone? How much pain do
you feel? Do you take any blood-thinning medicines?
 Tetanus shot depending on the type of fracture and if your immunization is current to
prevent tetanus due to the possible cause of the injury and for prophylaxis in the surgery.
 X-ray , CT scan , or MRI scan tests that take a picture of the broken bone and surrounding
areas to visualize the current bone condition of patient.
 An anesthesiologist will talk to the patient about anesthesia for your surgery.
 Arrange for a ride home from surgery.
 If surgery is urgent, may not have time to fast beforehand; make sure to tell doctor and the
anesthesiologist when the last meal was.
- Postoperative
Sonia Rufa Joy L. Singson BSN III – B April 19, 2011

 You may not use your operated limb to support any amount of body weight until your physician
instructs you to do so because it may injure the area which hasn’t healed yet.
 If you have an ice machine, use it as much as possible until your first post-op appointment to
prevent bleeding. There should be a cloth barrier between the ice pack and your skin at all times
to prevent possible irritation to the skin due to too much cold.
 Elevate your affected limb above your heart as much as possible after your surgery. Your
physician will tell you when it is no longer beneficial to elevate your injured limb. This is to help
prevent thrombosis formation.
 Do not drive until approved by your doctor. Do not drive if you are taking narcotics or muscle
relaxants as they can make you drowsy and slow your reaction time. This may cause some
adverse reactions such as dizziness or nausea and vomiting that disrupts you while driving.
 Do not remove your splint or brace that was put on after surgery until you are instructed to do so
by your physician. That supports your affected side where you have less control in moving and it
also helps steady the corrected area to be at place.
 You may require certain “assistive” devices (walker, crutches, cane, etc) for use at home to help
you with your activities of daily living. To assist activities of daily living.

Sources:
http://en.wikipedia.org/wiki/Internal_fixation
http://patton.lexipal.com/article/539804
http://orthopedics.about.com/cs/brokenbones/g/orif.htm
http://www.cliffsnotes.com/study_guide/Bone-Structure.topicArticleId-22032,articleId-21902.html
http://www.cliffsnotes.com/study_guide/Functions-of-Bones.topicArticleId-22032,articleId-21900.html
http://www.drugs.com/cg/open-reduction-and-internal-fixation-of-a-hip-fracture-discharge-care.html