What is Foot/Ankle Open Reduction and Internal Fixation?
Foot/ankle open reduction and internal fixation (ORIF) is a surgical method used to realign and stabilize broken bones in the foot or ankle. “Open reduction” refers to surgically exposing the fracture to restore proper alignment, while “internal fixation” involves securing the bones with metal hardware - such as plates, screws, or rods—to maintain stability during healing.
When is Foot/Ankle ORIF Recommended?
ORIF is recommended in cases where non-surgical treatment is unlikely to achieve stable, accurate bone healing. Common indications include:
- Displaced fractures of the ankle joint that alter its mechanics
- Unstable fractures of the heel (calcaneus) or midfoot (Lisfranc injuries)
- Open fractures where bone fragments pierce the skin
- Fractures involving joint surfaces with step-off or gaps
- Fractures that fail to heal correctly with casting or splinting
How is Foot/Ankle ORIF Performed?
The procedure typically follows these steps:
- Anesthesia and Preparation: The patient receives general or regional anesthesia. The surgical area is cleaned and draped to maintain sterility.
- Exposure and Reduction: A small incision is made over the fracture site. Soft tissue is carefully retracted to visualize bone fragments. The surgeon manipulates fragments back into their normal anatomical positions.
- Stabilization with Hardware: Once aligned, the bones are held together using metal plates and screws or intramedullary devices. Each implant is chosen to match the fracture pattern and bone quality.
- Closure: Soft tissues are repositioned, and the incision is closed with sutures or staples. A sterile dressing and a protective splint or boot are applied.
Recovery after Foot/Ankle ORIF
Postoperative care balances protection and gradual mobilization:
- Immobilization: The limb is kept in a cast, splint, or boot for 4–6 weeks to protect the repair.
- Weight-bearing: Depending on fracture stability, partial weight-bearing may begin at 6–8 weeks, progressing to full weight-bearing by 10–12 weeks.
- Physical Therapy: A tailored rehab program restores range of motion, strength, and balance over 3–6 months.
- Follow-Up Imaging: Periodic X-rays confirm bone healing and hardware position before advancing activity.
Risks of Foot/Ankle ORIF
As with any surgery, ORIF carries potential complications. Common risks include:
- Infection at the incision or around hardware
- Delayed healing or nonunion of the fracture
- Hardware irritation or failure requiring removal
- Nerve or blood vessel injury near the surgical site
- Joint stiffness or post-traumatic arthritis
Benefits of Foot/Ankle ORIF
When indicated, ORIF offers key advantages over non-operative care:
- Precise restoration of bone alignment and joint surface
- Stable fixation permitting earlier mobilization
- Reduced risk of malunion or permanent deformity
- Better long-term function and lower arthritis risk
- Predictable healing timeline under close surgical supervision
