What is Hip Fracture Treated With ORIF

A hip fracture is a break in the upper part of the thigh bone (femur). This is usually the result of an injury, often a fall. Open reduction with internal fixation (ORIF) is a common surgery used to fix a hip fracture or a broken hip. A surgical cut (incision) in the skin will be made to open the fracture area. This lets your health care provider see the broken bone. The bone pieces will then be put back together. Hardware, such as nails, pins, or compression screws will be used to hold the bone pieces in place.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Blood clot. This can form in the leg and travel to the lungs.
• Damage to nerves or other structures.
• Lung infection (pneumonia).
• Continuing pain.
• Difficulty walking.
• Failure of bones to heal.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

• A thorough medical exam will be done to ensure that you are healthy enough for surgery. Tests include:
  • A physical exam.
  • A test of how your nerves and veins work (neurovascular assessment).
  • Blood tests.
  • Urine test.
  • Electrocardiogram (ECG).
• You may have imaging tests such as X-rays, CT scan, or MRI.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have someone care for you for several days after you leave the hospital or clinic. This is important.
• Ask your health care provider what steps will be taken to prevent infection. These may include:
  • Removing hair at the surgery site.
  • Washing skin with a germ-killing soap.
  • Antibiotic medicine.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine that makes you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• Small monitors will be attached to your body. They will be used to check your heart, blood pressure, and oxygen level.
• You will receive an antibiotic through your IV during surgery.
• A catheter may be inserted into your bladder to collect urine while you are asleep.
• Your health care provider will:
  • Make an incision over the hip.
  • Move your bone pieces back into normal alignment and position.
  • Secure the bone pieces with hardware (nails, pins, or compression screws).
• X-rays may be taken to make sure the bone pieces are in the correct position.
• The incision will be closed with small stitches (sutures) or staples.
• A bandage (dressing) or some other kind of wound cover will be placed over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
• You may continue to receive fluids through the IV.
• You will receive additional antibiotics through your IV for the next 24 hours.
• You will be given medicine for pain as needed.
• You may receive a blood thinner to prevent blood clots.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You may be given instructions about how much body weight you can safely support on your injured leg (weight-bearing restrictions). You may be given crutches, a cane, or a walker to help you move around so that you do not bear any weight on your injured leg.
• You will be helped out of bed so you can begin moving around. This is important to improve blood flow and breathing.

Summary

• Open reduction with internal fixation (ORIF) is a common surgery used to fix a hip fracture or a broken hip.
• You will be given anesthetic medicines to make you fall asleep, and your health care provider will fix your fracture with nails, pins, or compression screws.
• After the surgery, you may receive a blood thinner or wear compression stockings to prevent blood clots.

Hip Fracture Treated With ORIF, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain. You will be given medicines to treat this.
• Swelling.
• Difficulty walking.
• Some redness or bruising around the incision.
• A small amount of fluid or blood from the incision.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• You may be given a blood thinner to take for up to six weeks. This will help reduce the risk of developing a blood clot. It is important to use this medicine exactly as directed.
• You may be given calcium and vitamin D supplements to strengthen your bones.
• If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.
  • Take an over-the-counter or prescription medicine for constipation.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths.
• Keep the bandage (dressing) dry until your health care provider says it can be removed.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your dressing. If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Managing pain, stiffness, and swelling

• If directed, put ice on the affected area to prevent pain and swelling.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) your leg above the level of your heart while you are sitting or lying down. To do this, try putting a few pillows under your leg.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider or physical therapist. This will help make your hip stronger and help you recover more quickly.
• Do not use your injured limb to support (bear) your body weight until your health care provider says that you can. Follow weight-bearing restrictions as told. Use crutches or other devices to help you move around (assistive devices) as directed.
• You may feel most comfortable using a raised surface when sitting on the toilet or in a chair.
• Consider using a toilet seat riser over the toilet for comfort.

Driving

• Do not drive or use heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe for you to drive.

General instructions

• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important. This may include visits for:
  • Physical therapy.
  • Screening for osteoporosis. Osteoporosis is thinning and loss of density in your bones.

Contact a health care provider if you:

• Have a fever.
• Have pain that is not helped with medicine.
• Have more redness, swelling, or pain at your incision area.
• Have more fluid or blood coming from your incision or leaking through your dressing.
• Notice that your incision feels warm to the touch.
• Have pus or a bad smell coming from your incision area.

Get help right away if you:

• Notice that the edges of your incision have come apart after the sutures or staples have been removed.
• Have pain, warmth, or tenderness in the back of your lower leg (calf).
• Have tingling or numbness in your leg.
• Have a pale and cold leg.
• Have trouble breathing.
• Have chest pain.

Summary

• After the procedure, it is common to have some pain and swelling.
• Take pain medicines as directed by your health care provider. Icing may also help with pain control.
• Contact your health care provider if you have signs of infection, severe pain, or more fluid or blood coming from your incision.