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

The femur is the large bone in the upper part of the leg. Different kinds of injuries can damage this bone, causing it to fracture into two or more pieces. This might happen in the part of the femur that's near the knee or near the middle of the femur or in the place where the femur forms part of the hip joint. Sometimes the femur breaks but the pieces still line up correctly. Sometimes the injury moves the bone pieces out of alignment (displaced fracture).

Depending on the type of fracture, you may 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, the surgeon makes a cut (incision) in your thigh and moves the bone pieces back into the correct position. This is different from a closed reduction. For that procedure, the doctor moves your 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, rods, 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. For a fracture in the long, middle part of the femur, the surgeon may insert a long metal rod through the center of the bone. The surgery usually takes place while you're asleep under general anesthesia.

Some health conditions may make fracturing your femur more likely. For example, osteoporosis increases the risk of fractures in many older adults. Your femur might also be more likely to break if you smoke or have bone tumors or cancer. Motor vehicle accidents, sports-related injuries, gunshot injuries, and falls are common types of injuries that can lead to a femur fracture. A direct blow to the hip may break the part of the femur linked to the hip joint.

Most people with a fractured femur need some sort of surgery, most often ORIF. Without the surgery, your broken femur may not heal correctly. ORIF can place your bones back into the right position. This increases the chance that the bones will heal the right way. A surgeon might advise treatment other than surgery for a very young child or for people with other health conditions that make surgery more risky.

You might need ORIF for a fracture that occurs anywhere along the femur, including the portion that forms part of your hip joint. In a broken hip, it is actually part of the femur that breaks and not part of the hipbone itself.

Most people do very well after ORIF for a femur fracture. But sometimes problems can occur. Possible problems include:

• Infection.
• Bleeding.
• Nerve damage.
• Blood clots.
• Fat clots (embolism).
• Bones that remain out of position or do not heal well.
• Pain or irritation in the skin and muscles that cover the screws and plates.
• 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, the kind of femur fracture you have, and other health conditions you have. For example, people with low bone mass or diabetes may be at greater risk for some problems. People who smoke may also have an increased risk for problems. 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 health history and do a physical exam. You'll have an image taken of your femur. This may be an X-ray or a CT scan. 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 a little later. If so, you might need to have your leg placed in traction while you wait for surgery. Talk to your doctor about how to prepare for the surgery. 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.

Your surgeon can explain the details of the 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 few 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 thigh, hip, knee, or any combination.
• The surgeon brings the pieces of your femur back into alignment (reduction).
• Next, the surgeon fastens the pieces of your broken femur together (fixation). They may use screws, metal plates, wires, or pins. For a fracture in the middle part of the femur, the surgeon may use a specially designed long metal rod that passes 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 thigh are closed up with stitches or staples.

Talk to your doctor about what to expect after surgery. You may have a lot of pain. But pain medicine can help reduce the pain. You should be able to go back to your 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 might be able to go home within the next few days.

Talk with your doctor about how you can move your leg and whether it's okay to put weight on it. This will depend on the type of injury you have. Follow all your doctor's instructions carefully. You might need to take blood-thinner medicine to prevent blood clots for a while after your surgery. 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, a high fever, chills, or severe pain. Also let your doctor know about any loss of feeling in your leg.

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 the exercises as prescribed can improve your chances for a full recovery. Most femoral fractures take about 4 to 6 months to heal completely. But you should be able to resume many activities before this time.

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.