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ORIF Surgery For Knee
Dr. Ambrose Yung
What is ORIF Surgery for the Knee?
ORIF (Open Reduction and Internal Fixation) is a surgical procedure used to repair complex fractures around the knee joint.
In this procedure, the bone is first realigned (open reduction), and then metal plates, screws, or rods are used to hold the bone in place (internal fixation) as it heals. ORIF surgery is typically used for fractures that cannot heal properly with non-surgical treatment, such as casting or splinting, and is required to restore knee stability and function.
Indications for ORIF Surgery
ORIF surgery is indicated when non-surgical treatments are insufficient to heal the knee fracture and is recommended for the following conditions:
Severe Knee Fractures
ORIF is recommended for fractures with multiple breaks or displaced bone fragments, which makes healing difficult without surgical intervention.
Fractures Involving the Joint
Fractures that extend into the knee joint itself may require ORIF surgery to realign the bones and preserve joint function, reducing the risk of long-term complications like arthritis.
Unstable Fractures
When a knee fracture causes instability and the bones cannot remain in place without support, ORIF surgery is needed to stabilise the knee during the healing process.
Complex or Non-Healing Fractures
Fractures that have not healed correctly with non-surgical methods like casting or bracing may require ORIF surgery to ensure proper bone alignment and healing. This is often seen in cases where fractures are complex, displaced, or located in critical areas of the knee joint.
Benefits of ORIF Surgery
ORIF surgery provides several advantages for patients with complex knee fractures, which include the following:
- Restores Bone Alignment
ORIF allows the surgeon to realign the fractured bones, helping them heal in the correct position and preserving proper knee function. - Promotes Stability
Internal fixation devices like metal plates and screws provide stability to the fracture, preventing the bone fragments from moving during the healing process. - Reduces Risk of Future Complications
ORIF reduces the likelihood of complications such as improper healing, arthritis, or long-term knee instability by ensuring the fractured bones are properly aligned and stabilised during recovery. - Improves Mobility
ORIF surgery helps improve mobility and reduces the risk of long-term joint stiffness and disability by restoring the knee structure.
Types of ORIF Surgery
The type of ORIF surgery varies depending on the location and type of fracture.
Patella ORIF
This procedure is used for fractures of the patella (kneecap). The surgeon uses metal pins or screws to reattach the bone fragments and stabilise the kneecap.
Tibial Plateau ORIF
Tibial plateau fractures occur at the top of the tibia (shinbone) near the knee joint. ORIF for tibial plateau fractures involves placing plates and screws to hold the bone fragments together and restore knee stability.
Distal Femur ORIF
This procedure addresses fractures of the distal femur, the lower part of the thigh bone. Metal plates and screws are used to stabilise the femur and ensure proper healing.
The Procedure
Preparing for Surgery
Several steps are necessary before ORIF surgery to ensure a smooth procedure and reduce the risk of complications.
- Medical Evaluation: Before surgery, X-rays or CT scans are performed to evaluate the fracture and plan the procedure. Blood tests may also be done to ensure the patient is fit for surgery.
- Medication Adjustments: Patients are advised to discontinue certain medications, particularly blood thinners or other medications that affect blood clotting, to reduce the risk of excessive bleeding during and after the procedure.
- Fasting: Patients are typically required to fast for 6 hours before surgery to reduce the risk of complications during anaesthesia.
Step-by-Step Procedure
Anaesthesia
General or spinal anaesthesia is administered to ensure the patient is pain-free during the procedure. The type of anaesthesia depends on the fracture location and patient health.
Incision and Bone Realignment
The surgeon makes an incision near the knee to access the fractured bone. The bone fragments are then realigned (open reduction) to restore their proper position.
Internal Fixation
Metal plates, screws, or rods are inserted to hold the bone fragments in place while they heal (internal fixation). These devices remain in the body unless they cause discomfort and require removal later.
Closure of Incisions
The incision is closed with stitches or staples, and the knee is bandaged. The internal fixation devices ensure that the bone stays aligned during the healing process.
Post-Operative Care and Recovery
After ORIF surgery, proper post-operative care ensures successful healing and restored knee function.
- Immediate Care: After surgery, the patient is closely monitored for any immediate complications, such as excessive bleeding or infection. Pain is treated with medications.
- Physical Therapy and Rehabilitation: Physical therapy typically starts with passive motion exercises to prevent stiffness. Patients may begin passive range-of-motion exercises early on, gradually progressing to active movement and weight-bearing as tolerated. Weight-bearing may be limited in the initial weeks, depending on the severity of the fracture.
- Follow-Up: Follow-up appointments are scheduled to monitor bone healing through X-rays and assess knee function. Additional rehabilitation may be needed to ensure full recovery.
Risks of ORIF Surgery
While most patients recover well, ORIF surgery carries some potential risks and complications. The most common include:
- Infection: Infection can develop at the incision site or around the internal fixation hardware, but antibiotics and proper wound care help to reduce the risk.
- Hardware Irritation: In some cases, the metal plates or screws used in the surgery may cause discomfort, requiring a second surgery to remove the hardware.
- Delayed Bone Healing: Although rare, the bones may heal at a slower rate or fail to align properly, which may require further treatment or revision surgery.
- Nerve or Blood Vessel Damage: There is a small risk of injury to the nerves or blood vessels near the knee during the procedure, which may cause numbness or reduced circulation.
Our Clinic Locations
Spire Hip & Knee Centre
6 Napier Road #08-04
Singapore 258499
Monday – Friday: 9.00am – 6.00 pm
Saturday: 9.00am – 1.00pm
Sunday & PH: CLOSED
Spire Orthopaedic Physiotherapy & Rehab Centre
101 Irrawaddy Road, #18-03
Singapore 329565
Monday – Friday: 9.00am – 6.00 pm
Saturday: 9.00am – 1.00pm
Sunday & PH: CLOSED
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Frequently Asked Questions (FAQ)
How long does it take to recover from ORIF surgery for the knee?
Recovery time varies, but most patients can expect full recovery within 6 to 12 months, depending on the severity of the fracture and adherence to physical therapy.
Can I return to normal activities after ORIF surgery?
Most patients can return to normal activities with proper rehabilitation, though high-impact activities may need to be avoided, depending on the injury’s severity.
Are there any long-term effects after ORIF surgery?
Most patients recover fully; however, some may experience long-term effects such as occasional pain or stiffness, especially if arthritis develops at the fracture site.