Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. You might need this procedure to treat your broken collarbone (clavicle).

The clavicle is a long, thin bone located between your breastbone (sternum) and the shoulder blade (scapula). It is the bone that connects the arm to the body. It is also called the collarbone. Different kinds of injuries can damage this bone, causing it to break (fracture) into two or more pieces. Most often, this happens along the middle of the bone. Sometimes the bone breaks near where it attaches to the sternum. Or it can happen near where it attaches to the shoulder blade.

In certain types of fractures, the clavicle has broken, but its pieces still line up correctly. In other types of fractures (displaced fractures), the injury moves the bone pieces out of alignment.

You might need a surgery called open reduction and internal fixation (ORIF) to bring your bones back into place and help them heal. The surgery is done by an orthopedic surgeon. This is a doctor who specializes in treating bone, muscle, joint, and tendon problems. During an open reduction, the surgeon cuts the skin so they can move the bone pieces back into their correct position.

Internal fixation is a method of reconnecting the bones. This might be done with special screws, plates, rods, wires, or nails. The surgeon puts these into the bone pieces to hold them in the correct position. This prevents the bone from healing in an abnormal way. The surgery usually takes place while you are asleep under general anesthesia.

Certain health conditions may make fracturing your clavicle more likely. For example, having weak, brittle bones (osteoporosis) increases the risk of fractures in many older adults.

You may fracture your clavicle from a direct blow to the shoulder. This can happen while playing a sport or if you're in a motor vehicle accident. Falling on an outstretched arm may also fracture a clavicle. Sometimes newborn babies fracture their clavicle during birth.

Not everyone with a fractured clavicle needs ORIF. In fact, most people don't. If possible, your doctor will treat your clavicle fracture with more conservative treatments. This means using treatments other than surgery. These treatments include pain medicines, splints, and slings.

You likely won't need ORIF unless there is some reason that your fracture might not heal normally with conservative treatments. You may need ORIF if:

• The pieces of your clavicle are very out of alignment.
• Your clavicle broke through the skin, or it looks like it may break through.
• Your clavicle broke into several pieces.

In these cases, ORIF can position your bones back into their correct alignment. This greatly increases the chances that your bone will heal correctly. In some cases, people might choose not to have ORIF even if the clavicle is very out of alignment. That's because the bone often heals correctly on its own. Your doctor can talk with you about the risks and benefits of ORIF. And they can discuss other treatments for your situation.

Most people do very well with ORIF. But rare problems sometimes occur after ORIF. Possible problems include:

• Broken screws or plates.
• Infection.
• Artery or vein damage.
• Nerve damage.
• Bones that remain out of position or do not heal well.
• An injury to the lung.
• Problems from anesthesia.

There is also a risk that the fracture won't heal the right way, and you'll need another surgery.

The risk of problems may vary based on your age, what kind of clavicle fracture you have, and any other health conditions you have. For example, people with low bone mass or diabetes may be at a higher risk of having problems. Smoking increases the risk of bones not healing and other problems. Ask your doctor about the risks that most apply to you.

ORIF is often done as an emergency or urgent procedure. Before your procedure, the doctor will ask about your health history and do a physical exam. You'll have an X-ray of your clavicle. Tell your doctor about all the medicines you take, including over-the-counter medicines such as aspirin. Also tell your doctor the last time you ate.

Sometimes ORIF is done as a planned procedure. If so, talk with your doctor about how to prepare for the procedure. Ask if there are any medicines you should stop taking ahead of time, like blood thinners. Follow any directions you are given about when to stop eating and drinking before your procedure.

The surgeon can help explain the details of your surgery. The details will depend on where the injury is and how severe it is. An orthopedic surgeon and trained assistants will do the surgery. An anesthesiologist will make sure you don't feel pain during the surgery. The whole procedure may take a couple of hours. In general, here is what to expect:

• You may get general anesthesia, so you'll sleep through the surgery and won't feel anything. Or you may get local anesthesia and a medicine to help you relax.
• Your heart rate, blood pressure, and other vital signs will be carefully watched. You may have a breathing tube placed down your throat during surgery to help you breathe.
• After cleaning the affected area, the surgeon makes a cut (incision) through the skin and muscle near your clavicle.
• The surgeon brings the pieces of your clavicle back into alignment (reduction).
• Next, the surgeon fastens the pieces of clavicle to each other (fixation). To do this, they may use screws, metal plates, wires, or pins. (Ask what the surgeon will use for your surgery.)
• The surgeon may make other needed repairs.
• After the bones are secured, the layers of skin and muscle around your clavicle are closed up with stitches or staples.

Talk with your doctor about what to expect after your surgery. You will have some pain. But pain medicine can help reduce the pain. You should be able to go back to a normal diet quickly. You will likely need an imaging test, such as an X-ray, to make sure the surgery was successful. Depending on how severe your injury is and any other health conditions you have, you may be able to go home the same day.

For a while after your surgery, you'll need to keep your arm from moving. Often this means that you will need to wear your arm in a sling for several weeks. You'll get instructions about how you can move your arm.

Your doctor might give you other instructions about caring for your clavicle, such as applying ice. Follow all your doctor's instructions carefully. Your doctor might not want you to take certain over-the-counter medicines for pain. That's because some of these can interfere with bone healing. Your doctor may advise you to eat a diet high in calcium and vitamin D as your bone heals.

After surgery, some fluid may drain from your incision. This is normal. Contact your doctor right away if:

• You have an increase in redness, swelling, or drainage from your incision.
• You have a high fever or chills.
• You have severe pain.
• You have a loss of feeling anywhere in your body.
• You have shortness of breath or chest pain.
• You have redness and swelling in your arm.

Be sure to go to all of your follow-up appointments. You may need to have your stitches or staples removed a week or so after your surgery.

At some point, you may need physical therapy to restore strength and flexibility to your muscles. Doing your exercises as prescribed can improve your chances for a full recovery. Most people are able to return to all their normal activities in a few months.

Before you agree to any test or procedure, make sure you know:

• The name of the test or procedure.
• The reason you are having the test or procedure.
• What results you can expect and what they mean.
• The risks and benefits of the test or procedure.
• What side effects or problems are possible.
• When and where you will have the test or procedure.
• Who will do the test or procedure and what that person's qualifications are.
• What may happen if you don't have the test or procedure.
• Whether there are any alternative tests or procedures to think about.
• When and how you will get the results.
• Who to call after the test or procedure if you have questions or problems.
• How much you may need to pay for the test or procedure.