What is open reduction with internal fixation?

Open reduction with internal fixation is a type of surgery to fix a broken (fractured) bone. The doctor makes a cut, called an incision, in the skin over the bone. The doctor then moves the pieces of bone back into the normal position. This is called open reduction. The doctor may use special screws, pins, plates, or rods to hold the bone in place while it heals. This is called internal fixation. These devices may stay in your child's body from now on. The doctor closes the incision with stitches. Your child will have a scar, but it will fade with time.

Your child may spend a few hours to a few days in the hospital. The length of the stay depends on how serious your child's injury is. It usually takes weeks to months for a broken bone to heal.

The doctor may give you specific instructions on when your child can do normal activities again, such as sports and going back to school or work. After the bone has healed, your child may need physical therapy to make the area strong and flexible again.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Increase your activity as recommended by your doctor. Being active boosts blood flow and helps prevent pneumonia and constipation. It's usually okay to exercise other parts of your body as soon as you feel well enough.
• Avoid putting weight on your repaired bone until your doctor says it is okay.
• You will probably need to take 1 to 2 weeks off from work. It depends on the type of work you do and how you feel.
• Do not shower for 1 or 2 days after surgery. When you shower, keep your dressing and incisions dry. If you have a cast, tape a sheet of plastic to cover it so that it does not get wet. It may help to sit on a shower stool.
• Do not take a bath, swim, use a hot tub, or soak your affected limb until your incision is healed. This usually takes 1 to 2 weeks.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
• If you do not have a cast, clean the incision 2 times a day after your doctor allows you to remove the bandage. Use only soap and water to clean the incision unless your doctor gives you different instructions. Don't use hydrogen peroxide or alcohol, which can slow healing.

Exercise

• Do exercises as instructed by your doctor or physical therapist. These exercises will help keep your muscles strong and your joints flexible while your bone is healing.
• Wiggle your fingers or toes on the injured arm or leg often. This helps reduce swelling and stiffness.

Ice and elevation

• Prop up the injured arm or leg on a pillow when you ice it or anytime you sit or lie down during the first 1 to 2 weeks after your surgery. Try to keep it above the level of your heart. This will help reduce swelling and pain.

Other instructions

• If you have a cast or splint:
  • Keep it dry.
  • If you have a removable splint, ask your doctor if it is okay to take it off to bathe. Your doctor may want you to keep it on as much as possible. Be careful not to put the splint on too tight.
  • Do not stick objects such as pencils or coat hangers in your cast or splint to scratch your skin.
  • Do not put powder into your cast or splint to relieve itchy skin.
  • Never cut or alter your cast or splint.

Surgery can be stressful for both your child and you. This information will help you understand what you can expect. And it will help you safely prepare for your child's surgery.

Preparing for surgery

• Your child may need to shower or bathe with a special soap the night before and the morning of surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your child's skin that could cause an infection after surgery.
• Talk to your child about the surgery. Tell your child that it will help the bone heal. Hospitals know how to take care of children. The staff will do all they can to make it easier for your child.
• Do not shave the skin near the fractured bone for 2 or 3 days before surgery. This will reduce your child's risk of infection after surgery.
• You and your child may talk with a child life specialist. This person can answer questions about your time in the hospital.
• Ask if a special tour of the surgery area and hospital is available. This may make your child feel less nervous about what happens.
• Plan for your child's recovery time. Your child may need more of your time right after the surgery, both for care and for comfort.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell the doctor ALL the medicines, vitamins, supplements, and herbal remedies your child takes. Some may increase the risk of problems during the surgery. Your doctor will tell you if your child should stop taking any of them before the surgery and how soon to do it.

The day before surgery

• A nurse may call you (or you may need to call the hospital). This is to confirm the time and date of your child's surgery and answer any questions.
• Remember to follow your doctor's instructions about your child taking or stopping medicines before surgery. This includes over-the-counter medicines.

Your broken bone (fracture) was put into position and stabilized. You can expect some pain and swelling around the cut (incision) the doctor made. This should get better within a few days after your surgery. But it is normal to have some pain for 2 to 3 weeks after surgery and mild pain for up to 6 weeks after surgery.

How soon you can return to work and your normal routine depends on your job and how long it takes the bone to heal. For example, if you have a fractured leg and you sit at work, you may be able to go back in 1 to 2 weeks. But if your job requires you to walk or stand a lot, you will need to wait until your fracture has healed before you go back to work.

• Follow the instructions exactly about when your child should stop eating and drinking. If you don't, your child's surgery may be canceled. If your doctor told you to have your child take any medicines on the day of surgery, have your child take them with only a sip of water.
• Follow the doctor's instructions about when your child should bathe or shower before the procedure. Do not apply lotion or deodorant.
• Your child may brush their teeth. But tell your child not to swallow any toothpaste or water.
• Do not let your child wear contact lenses. Bring your child's glasses or contact lens case.
• Have your child take off all jewelry and piercings.
• Be sure your child has something that's a reminder of home. A special stuffed animal, toy, or blanket may be comforting. For an older child, it might be a book or music.

At the hospital or surgery center

• A parent or legal guardian must accompany your child.
• Your child will be kept comfortable and safe by the anesthesia provider. The anesthesia may make your child sleep. Or it may just numb the area being worked on.
• The surgery will take about 1 to 2 hours. But it can take longer, depending on how serious the fracture is.
• After surgery, your child will be taken to the recovery room. As your child wakes up, the recovery staff will monitor your child's condition. The doctor will talk to you about the surgery.