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

The humerus is the bone in the upper part of your arm. Different kinds of injury can damage this bone. This usually results from a direct blow to the arm from a fall or collision, causing it to fracture into two or more pieces. This might happen in the part of the humerus near your shoulder or near the middle of the humerus or in the part of the humerus near your elbow. Sometimes a bone breaks but the pieces still line up correctly. Sometimes the injury moves the bone fragments out of position (displaced fracture).

Depending on the type of fracture, you might need 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 open reduction surgery, the surgeon makes a cut (incision) in the upper arm and moves the bone pieces back into the correct position. In a closed reduction, a doctor moves the bones back into place without making an incision.

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

Some health conditions may make fracturing your humerus more likely. For example, osteoporosis increases the risk of fractures in many older adults.

Not everyone with a fractured humerus needs ORIF. In fact, most people don't. If possible, your doctor will treat your arm fracture with other treatments, like pain medicine, splints, and slings.

You likely won't need ORIF unless there is some reason that your fracture might not heal the right way with these other treatments. You are likely to need ORIF if:

• The pieces of your humerus are very out of alignment.
• Your humerus broke through the skin.
• Your humerus broke into several pieces.

In these cases, ORIF can align the bones back into the right position. This greatly increases the chance that your bone will heal correctly.

You might need ORIF for a fracture that occurs anywhere along your humerus, including the portions near the shoulder and the elbow.

In some cases, your doctor might discuss other surgical choices with you, like a shoulder replacement if you have severe damage to the top of your humerus. Talk to your doctor about the risks and benefits of all your choices.

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

• Screw perforation of the humeral head.
• Broken screws or plates.
• Infection.
• Bleeding.
• Nerve damage.
• Tissue death due to low blood supply (avascular necrosis) in the humerus.
• Loss of range of motion.
• Bones that remain out of position or do not heal well.
• Problems from anesthesia.

There is also the 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, how and where your humerus is broken, and any other health conditions you have. For example, people with low bone mass or diabetes may be at higher risk of having problems. People who smoke may also have an increased risk. Ask your doctor about the risks that most apply to you.

ORIF is often done as an urgent procedure. Before your procedure, the doctor will ask about your medical history and do a physical exam. You'll have an image taken of your humerus. This may be an X-ray, CT scan, or MRI. Tell your doctor about all the medicines you take, including over-the-counter medicines like 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. 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 explain the details of your surgery. The details will depend on where the fracture 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 surgery may take a couple of hours. In general, here's 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 of your arm. Or the surgeon might make an incision through the top of the shoulder instead.
• The surgeon brings the pieces of your humerus back into alignment (reduction).
• Next, the surgeon fastens the pieces of your broken humerus together (fixation). They may use screws, metal plates, wires, or pins. For a fracture in the middle of the upper arm, a special metal rod may be put through the middle of the bone. It screws into the bone at both ends. (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 arm are closed up with stitches or staples.

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

Many people begin exercises to improve motion shortly after surgery. Depending on how severe your fracture is and the type of surgery you have, you may be restricted for some time from using your injured arm for certain activities. This may include lifting, pushing, or pulling activities (including opening and closing doors). You'll get instructions about how you can move your arm. You may need to wear a splint or cast for several weeks. Be sure to protect it from water.

The doctor might give you other instructions about caring for your arm, like applying ice. Follow all the 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 in your arm.
• You have a loss of feeling in your arm or hand.

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 some sort of 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 within a few months.

Before you agree to a 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 to 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.