What Are Open Reduction and Internal Fixation of Distal Femoral Fractures in Adults?

Open reduction and internal fixation (ORIF) of a displaced distal femur fracture involves surgically fastening hardware to the bone so it heals in the correct position.

The femur, commonly known as the thigh bone, is the largest bone located in the upper part of your leg. Trauma from a motor vehicle accident, a fall from a height or sports injuries can  fracture the thigh bone into two or more pieces. 

In certain types of femur fractures, the bone pieces are still in place and aligned correctly. In other types of fractures (displaced fractures), the trauma displaces the broken pieces of the femur.

Femur fractures that occur near to your knee (distal femur) are known as distal femoral fractures. Distal femoral fractures might end up damaging your knee, especially if you are an elderly person.

Certain medical conditions put you at risk of femur fracture. These include:

• Brittle and porous bones (osteoporosis) during old age 
• Osteomyelitis (infection of the bone)
• Bone cancer

Open reduction and internal fixation (ORIF) is a commonly used surgical treatment for bone fractures, including the femur. 

ORIF places the pieces of the broken femur together and allows healing of the fracture. This is done using special pieces of artificial hardware that hold the bone fragments in the correct position.

You are likely to need an ORIF of femur if:

• You have an open fracture (part of your femur breaks through the skin).
• You have a displaced fracture of the femur.
• Your femur has broken into more than two pieces. 
• You have femur fracture due to an existing bone disease like osteoarthritis.

• The surgery is done by an orthopedic surgeon — a doctor specialized in treating diseases of the muscles and bones.
• General anesthesia will make you sleep throughout the procedure so that you will not feel any pain. 
• After cleaning the affected area with an antiseptic solution, the surgeon will make anincision through the skin and muscles of your thigh until he can see the femur. 
• Your surgeon will align the broken pieces of your femur (open reduction).
• Next, your surgeon will attach the pieces of your femur with the help of screws, wires, nails, pins or metal plates (internal fixation). This holds the aligned pieces of the broken femur secure.
• The muscles around your thigh will be sutured closed,  followed by covering the surgical wound with a bandage.

• You will be shifted to the surgical ward and your leg will be positioned in a neutral position to avoid strain on the tendons.
• Generally, you can resume a normal diet right from the next day of surgery.
• You will be given painkillers for several days. 
• Your surgeon might order an X-ray of the repaired femur to confirm the success of the surgery. 
• Depending on the extent of your injury and your other medical conditions, you might be discharged within three to seven days.
• You will need to protect your wound from water by tying plastic around your leg whenever you take a shower.
• You will be encouraged to move around with the help of support like crutches, walker or cane.
• Eating a diet high in calcium and vitamin D will help in faster healing.
• Clean and change the dressings on your wound daily to speed its healing.
• Your surgeon will refer you to a physical therapist to restore your leg and knee joint mobility. The therapist will teach you the appropriate exercises to strengthen your muscles and ensure stability.
• Recovery from femur fractures usually takes about four to six months, and it depends upon how extensive your injury is.

All surgeries carry some risks. The risks of ORIF of femoral fractures include:

• Surgical wound infection that spreads to the femur
• Bleeding from the surgical wound
• Damage to nerves adjacent to the femur
• Malunion (bone healing out of  alignment, leading to abnormal bony growth)
• Blood clot in the leg
• Blood clot in the lung
• Skin irritation due to the hardware
• Arthritis of knee

Some conditions like smoking, diabetes and having weak bones put you at higher risks after the surgery. In such cases, your doctor will advise you to quit smoking tobacco for at least a few months if you can’t manage permanent cessation. They will also refer you to a diabetologist for modifying your anti-diabetic treatment or give you medications to strengthen your bones.