Internal fixation is an operation in

orthopedics Orthopedic surgery or orthopedics (American and British English spelling differences, alternative spelling orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgic ...

that involves the surgical implementation of implants for the purpose of repairing a

bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...

, a concept that dates to the mid-nineteenth century and was made applicable for routine treatment in the mid-twentieth century. An internal fixator may be made of

stainless steel Stainless steel, also known as inox, corrosion-resistant steel (CRES), or rustless steel, is an iron-based alloy that contains chromium, making it resistant to rust and corrosion. Stainless steel's resistance to corrosion comes from its chromi ...

titanium alloy Titanium alloys are alloys that contain a mixture of titanium and other chemical elements. Such alloys have very high tensile strength and toughness (even at extreme temperatures). They are light in weight, have extraordinary corrosion resistance ...

, or cobalt-chrome alloy. Types of internal fixators include: * Plate and screws * Kirschner wires * Intramedullary nails

Open reduction

Open reduction internal fixation (ORIF) involves the implementation of implants to guide the healing process of a bone, as well as the open reduction, or setting, of the bone. ''Open reduction'' refers to

open surgery Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definitio ...

to set

s, as is necessary for some

fracture Fracture is the appearance of a crack or complete separation of an object or material into two or more pieces under the action of stress (mechanics), stress. The fracture of a solid usually occurs due to the development of certain displacemen ...

s. ''Internal fixation'' refers to fixation of screws and/or plates,

intramedullary rod An intramedullary rod, also known as an intramedullary nail (IM nail) or inter-locking nail or Küntscher nail (without proximal or distal fixation), is a metal rod forced into the medullary cavity of a bone. IM nails have long been used to treat ...

s and other devices to enable or facilitate

healing With physical trauma or disease suffered by an organism, healing involves the repairing of damaged tissue(s), organs and the biological system as a whole and resumption of (normal) functioning. Medicine includes the process by which the cells ...

. Rigid fixation prevents micro-motion across lines of fracture to enable healing and prevent infection, which happens when implants such as plates (e.g.

dynamic compression plate A dynamic compression plate (DCP) is a metallic plate used in orthopedics for internal fixation of bone, typically after fractures. As the name implies, it is designed to exert dynamic pressure between the bone fragments to be transfixed. Dynamic ...

) are used. ORIF techniques often are used in cases involving serious fractures such as comminuted or displaced fractures or, in cases where the bone otherwise would not heal correctly with casting or splinting alone. Risks and complications may include bacterial colonization of the bone,

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

, stiffness and loss of range of motion, non-union, mal-union, damage to the muscles, nerve damage and palsy,

arthritis Arthritis is a general medical term used to describe a disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, Joint effusion, swelling, and decreased range of motion of ...

tendonitis Tendinopathy is a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder ( rotator cuff tendinitis, biceps tendinitis), elbow ( tenn ...

, chronic

pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...

associated with plates, screws, and pins,

compartment syndrome Compartment syndrome is a serious medical condition in which increased pressure within a Fascial compartment, body compartment compromises blood flow and tissue function, potentially leading to permanent damage if not promptly treated. There are ...

deformity A deformity, dysmorphism, or dysmorphic feature is a major abnormality of an organism that makes a part of the body appear or function differently than how it is supposed to. Causes Deformity can be caused by a variety of factors: *Arthritis a ...

, audible popping and snapping, and possible future surgeries to remove the hardware.

Closed reduction

Closed reduction internal fixation (CRIF) is reduction without any open surgery, followed by internal fixation. It appears to be an acceptable alternative in unstable distressed lateral

condylar fracture A condyle (;Entry "condyle"
in

s of the

humerus The humerus (; : humeri) is a long bone in the arm that runs from the shoulder to the elbow. It connects the scapula and the two bones of the lower arm, the radius (bone), radius and ulna, and consists of three sections. The humeral upper extrem ...

in children, but if fracture displacement after closed reduction exceeds 2 mm, open reduction and internal fixation is recommended. Various techniques of minimally invasive surgery for internal fixation of bones have been reported. The treatment of fractures of the distal third of the tibia has evolved with the development of improved imaging and surgical techniques.

Internal fixation implants for intracapsular hip fractures in older adults

The latest evidence suggests that there may be little or no difference between screws and fixed angle plates as internal fixation implants for intracapsular hip fractures in older adults. The findings are based on low quality evidence that cannot firmly conclude major difference in hip function, quality of life, and additional surgery.

Additional images

$X ray internal fixation leg fracture$

References

External links