Open Reduction and Internal Fixation of Fractures o the tibial

shaft

Discussion
An open reduction internal fixation (ORIF) refers to a surgical
procedure to fix a severe bone fracture, or break. Open
reduction means surgery is needed to realign the bone fracture
into the normal position. Internal fixation refers to the steel
rods, screws, or plates used to keep the bone fracture stable in
order to heal the right way and to help prevent infection.

The surgical procedure is performed by a doctor who specializes

in orthopedics, which is a branch of medicine concerning the
musculoskeletal structure of the body. Under general anesthesia,

an incision is made at the site of the break or injury, and the

fracture is carefully re-aligned or the joint replaced. The
hardware is installed, and the incision is closed with staples or
stitches. The steel rods, screws, or plates can be permanent, or
temporary and removed when healing takes place.
Once the open reduction internal fixation is performed, a cast is
usually applied. In the case of an ankle fracture, for instance,
the first cast is a non-weight bearing cast, and crutches can be
used to help keep weight off the healing bones. Later, when the
healing has progressed, this cast will be replaced with one that
can bear weight. Eventually, after a period of some weeks, the
cast will be removed entirely.
The type of fixation device is determined by the anatomic
considerations of the fracture (e.g, comminuted, spiral , or
open. Severely comminuted fractures may have to be treated with
prolonged traction rather than fixation.

Procedure
The fracture is exposed in which transverse bone screws or
plates (including compression plates) may be applied to reduce
fracture fragments. In addition, after the fragments have been
reduced, an intramedullary nail or rod may be employed to fix a
fractured tibia and provide rotational stability. An ender nail
is slightly curved and semi elastic.

An incision about the

tibia tuberosity is made. A drill reamer penetrates the medullary

canal. The measured nail is inserted and aligned to avoid
malrotation or shattering the shaft of the tibia. Loose fragments

and debris may be pulse ravaged or irrigated with saline or

antibiotic solution. The ender nail is then driven past the
fracture site into the distal portion until the threaded end
remains exposed. A counter incision over the fracture site may be
needed to effect reduction. Again, care is taken during the
driving of the nail to avoid injury to the shaft. Use of multiple
ender nails can improve rotational stability fanning of the
proximal end helps control rotation. Small bones or fractures at
the insertion site may complicate use of Ender nails. X rays are
taken to visualize and document the repair

Preparation of the Patient

An antiembolitc shocking may be placed on the unaffected
extremity, as requested. General anesthesia or regional block
anesthetic may be employed. The patient is supine; arms may be
extended on padded arm boards. The safety straps is secured over
the blanket-covered unaffected extremity.
Skin Preparation. Care is taken to support the extremity to avoid
further injury. Begin at the fracture site; prep the entire
extremity, Include the leg, thigh and foot

Draping
The supported leg is abducted and elevated the foot is grasped
and covered by tube stockinet, A large sheet is draped over the
end of the table. The stockinet is brought up (unrolled to the
level of the tourniquet. A folded towel is wrapped around the top
of the stockinet and secreted. A split sheet is draped under the

leg, or the leg may be passed through a sheet with a rubberized

fenestration.

ASSESSMENT

EXPLANTION OF
PROBLEM

S>
hind

Objectives

Nursing
Interventions

Rationale

Evaluation