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.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Do not shave the skin near the fractured bone for 2 or 3 days before surgery. This will reduce your risk of infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Have your child rest when feeling tired.
• Increase your child's activity as recommended by your doctor. Being active boosts blood flow and helps prevent pneumonia and constipation. It's usually okay for your child to exercise other parts of the body as soon as your child feels well enough.
• Help your child keep all weight off of the repaired bone until your doctor says it is okay.
• Your child will probably need to take 1 to 2 weeks off from school or work.
• Your child may shower 24 to 48 hours after surgery. When your child showers, be sure to keep the dressing and incisions dry. If your child has a cast, tape a sheet of plastic to cover it so that it doesn't get wet. It may help if your child sits on a shower stool.
• Your child should not take a bath, swim, use a hot tub, or soak the affected limb until the incision is healed. This usually takes 1 to 2 weeks.

Diet

• Your child can eat a normal diet. If your child's 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 your child can restart any medicines. The doctor will also give you instructions about any new medicines.
• If your child takes aspirin or some other blood thinner, be sure to talk to your doctor. The doctor will tell you if and when your child can start taking this medicine again. Make sure that you understand exactly what your doctor wants you to do.
• If the doctor gave your child a prescription medicine for pain, give it as prescribed.
• If your child is not taking a prescription pain medicine, ask the doctor if your child can take an over-the-counter medicine.
• If your doctor prescribed antibiotics, give them to your child as directed. Do not stop giving them just because your child feels better. Your child needs to take the full course of antibiotics.

Incision care

• If your child has strips of tape on the cut (incision) the doctor made, leave the tape on for a week or until it falls off.
• If your child doesn't have a cast, clean the incision 2 times a day after your doctor allows your child 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. They can slow healing.

Exercise

• Help your child follow instructions from your doctor or physical therapist about what exercises to do. These exercises will help keep your child's muscles strong and the joints flexible while the bone is healing.
• Have your child wiggle their 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 your child ices it or anytime your child sits or lies down during the first 1 to 2 weeks after surgery. Try to keep it above the level of the heart. This will help reduce swelling and pain.

Other instructions

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