Open reduction internal fixation, referred as ORIF is a type of surgery that can stabilize and heal a broken bone. This procedure is mostly recommended to repair fractures that will not heal correctly with the help of casting or splints alone. The surgical method differs based on the location and type of fracture.
Orthopedics surgeries are most commonly performed procedures these days. ORIF surgery in India is done by some of the most experienced, famed and skilled orthopedic surgeons. The quality of diagnosis, treatment and the safety measures are comparable to any country across the globe. Majority of the hospitals in India have innovative technology like robotic surgery, world-class medical facilities, and infrastructure. All these benefits are available at affordable prices making India one of the preferred destinations for medical tourism.
ORIF surgery cost in India along with the quality of treatment and aftercare taken is on par with some of the most popular medical tourism destinations in Hungary, Thailand, Singapore, Turkey, and UAE. The cost of ORIF is available at almost half the price when compared with the value offered in US or UK.
Open reduction internal fixation (ORIF) procedure aims at fixing a bone fracture that is considered to be very serious and in case realignment of the bone to the normal position is required with the help of screws, plates and other equipment.
ORIF surgery is a common procedure and is applicable for different bone segments of the body, including the hip, knee, arms, and thighs. ORIF surgery is performed by orthopaedic surgeons who have specialization in the musculoskeletal structure of the human body.
ORIF surgery is performed to stabilize the broken bone, which could be in any part of the body. The following are some of the common conditions that are treated with the help of an ORIF surgery:
● The bone pieces such as knee, hip, tibia-fibula, humerus, and femur are significantly out of alignment
● The bone pieces are piercing out through the skin
● The part of the bones in the above-mentioned parts of body is fractured, leading to formation of several pieces
● The fracture involves a knee joint
● The healing of the bones is not normal even after undergoing conservative treatment
Open reduction means open surgery aimed to set the bones as may be necessary after a fracture, while internal fixation means fixing of plates or screws and intramedullary bone nails in the case of humerus, tibia or femur bones to facilitate in the overall process of healing.
Micro motion across the lines of fracture is prevented with rigid fixation which not only helps promote healing but also prevents further infection which can happen when plates such as dynamic compression plates are used as implants.
Once the patient is under the influence of anesthesia, an incision is made at the site of the injury or the break and then the fracture is carefully realigned or the joint is replaced with extreme precision. The hardware required will be installed and the incision made will be closed with the help of stitches and staples. The inserted implants such as rods, pins, screws, and plates are permanent in many cases. In some cases, the implants are temporary and can be removed when the healing begins.
A cast is usually applied after ORIF surgery. Later when the healing process has sufficiently progressed, this cast will be replaced with something that is capable of bearing better weight than that. The cast is completely removed after a few weeks of the ORIF surgery. The following are the different types of ORIF procedures, depending on the locations of the fracture:
Occasionally cerclage wiring is used alone or in combination with a tension band wiring. If the surgeon allows, then K-wires can also be used. The reduction is checked by palpating the retropatellar surface (which requires a small arthrotomy) while the cerclage is tightened with the knee in extension.
The proximal pin ends are bent after the cerclage is tightened. They are further shortened and turned towards the quadriceps tendon and then it is driven into the patella to prevent any skin irritation and further loosening.
To remove sharp points, the distal pin ends are trimmed but then it is not bent for the purpose of easy removal. Two twists can be preferred by some surgeons to tighten the cerclage wire. But then they have to take extra care to ensure that no extra prominent wires are left protruding.
As the wires get twisted, the surgeon pulls it away from the patella to have them tightened. To prevent fixation failure, the wires should be twisted at least 5 times. When stainless steel wires are tightened, they tend to lose the sheen of the surface and it can break with further tightening. Some care is taken to eventually have the twisted wire positioned deeper into the soft tissue muscle layers. This procedure is used to treat a fractured knee or a fractured patella.
ORIF surgery for the ankle is performed in the prone position and a bump is placed under the ipsilateral hip. The patient may also be placed in the lateral decubitus position if medial malleolus fracture is not present.
Just medial to the posterior border of the fibula bone, a longitudinal incision is placed which allows good access to the Volkmann’s fragment and to the lateral malleolus. The sural nerve and saphenous vein are identified and protected.
The anatomy of the sural nerve is highly variable and hence meticulous blunt dissection has to be performed in the subcutaneous tissue. To gain access to the posterior aspect of the lateral malleolus, the peroneal tendons must be retracted medially. With the help of a lag and an antiglide plate, the fibular fracture is fixed classically but the construct of the fixation can vary depending upon the comminution and the fracture pattern.
Limited contact dynamic compression plate or one-third tubular plate can be employed to give additional stability in complicated fracture patterns. The latter plate is contoured by having the corners narrowed at the distal end to fit closely over distal fibula’s posterior border.
Within the wound, a second interval is further exploited between the Achilles tendon and the peroneal tendon more medially. From the posterior tibia, the flexor hallucis longus is lifted up to allow access to the posterior malleolus. Via the perimalleolar arterial, ring blood is supplied to the tibia. The fracture edge must be defined and devascularization of the fragment should not happen. In order to supplement the fixation, a small buttress plate can also be employed.
Through a standard medial incision, the medial malleolus can be addressed, but this can be challenging in a prone position when compared to the supine position due to the tendency of the leg to rotate externally. Hence it is good to have an assistant to hold the lower limb in case of internal rotation. Usually, with the help of two of the 3.5 lag screws, fixation of the medial side will be carried out.
Supracondylar fractures are common among femur fractures occurring proximal to the knee joint in the terminal of the femur in between the metaphyseal-diaphyseal junction and the femoral condyles. ORIF femur includes treatment of the fracture by incorporating intramedullary nails, plates and external fixators or total knee arthroplasty. The technique adopted will depend upon the bone quality and hemodynamic stability of the patient.
The angled blade plate of 95 degrees is a one-piece fixed angle device having a blade to be inserted in the condyles distally. But condylar screw system is much easier to use than angled blade plate. In the plate position, sagittal plane adjustments can be made which is not possible with blade plate. With an intercondylar split, the condylar screw is able to provide interfragmentary compression for the fractures.
With a cloverleaf distal portion that can be contoured, the condylar buttress plate is broad and can fit the lateral aspects of the distal femur. For the purpose of minimally displaced fractures, it can be used and most useful when fractures with articular extension in the sagittal and coronal planes have to be addressed. It is also used as an intraoperative backup device when some amounts of difficulties are faced while using the condylar screw system or the angled blade plate. In LISS or the less invasive stabilization system, a locking plate and a screw construct are used which ensures the preservation of the periosteal blood supply to the fracture. LISS plate is more useful in the case of osteoporotic bone.
The broken parts of the femur bone at the neck are put back in this surgery. The incision is made in the hip to view the damaged bone. The femur is straightened and broken pieces of the bone are put together.
Special metals, bars, plates, rods, screws can be used to keep the broken pieces together. An artificial implant may be placed to have the head of the femur specifically replaced. If the hip joint is also injured, an implant is placed to replace the hip socket too.
One of the main components of recovery is pain management after ORIF surgery. ORIF recovery time varies from one patient to the other, It also depends on the exact location of the surgery. ORIF ankle surgery recovery time is different from that of ORIF surgery of the hip. Recovery is typically painful and hence proper pain management is required after the ORIF surgery. Acetaminophen and codeine are usually prescribed. Research results reveal that ibuprofen or other kinds of nonsteroid anti-inflammatory drugs can slow down the process of healing during the recovery period. So these should be avoided during the recovery period.
Healing regimen physical therapy is also introduced during the recovery period since the body part that suffered the trauma will be held in an immobilized position for a very long period of time. As a result, the tendons, ligament, and muscles may grow weak with time.
With physical therapy, the strength comes back and endurance of the affected area increases with a range of motion. Physical therapy includes exercises, nerve stimulation, cold and hot packs, and ultrasound.
While depending upon a range of factors, the minimum cost for ORIF in India is USD 4700. ORIF in India is conducted across several NABH, JCI certified hospitals.
Different hospitals have different pricing policy when it comes to the cost of ORIF in India. The top hospitals for ORIF in India covers all the expenses related to the pre-surgery investigations of the candidate. The ORIF procedure in India includes the fees of the surgeon, hospitalization and anesthesia as well. Extended hospital stay, complications after the surgery or new diagnosis may affect the overall cost of ORIF in India.
After discharge from the hospital, the patient has to stay for another 14 days in the country for complete recovery. This is important to ensure that the surgery was successful. During this time, control and follow-up tests take place to check for medical fitness.
While India is considered to be one of the best destinations for ORIF owing to the standard of Hospitals, and expertise of doctors; there are a select few destinations which provide comparable quality of healthcare for the procedure Some of such countries are:
|United Arab Emirates||USD 8200|
|United Kingdom||USD 10500|
Apart from the ORIF cost, there are a few other daily charges that the patient may have to pay. These are the charges for daily meals and accommodation outside the hospital. These charges starts from USD 50 per person.
ORIF in India is offered in almost all metropolitan cities, including the following:
There are many ORIF surgeons who offer video telemedicine consultation to patients who need this treatment. Some of them include the following:
|Doctor||Cost||Schedule Your Appointment|
|Dr. Sujoy Kumar Bhattacharjee||USD 14||Schedule Now|
|Dr. Mandeep Singh||USD 18||Schedule Now|
|Dr. Saif Nabi Shah||USD 13||Schedule Now|
|Dr. Vibhore Singhal||USD 35||Schedule Now|
The average duration of stay at the hospital after ORIF is about 2 days for proper care and monitoring. The patient is subjected to several biochemistry and radiological scans to see that everything is okay and the recovery is on track. After making sure that patient is clinically stable, discharge is planned.
The average rating for ORIF hospitals in India is 3.9. Several parameters such as hospital infrastructure, pricing policy, quality of services, politeness of staff etc. contribute to the rating.
There are more than 60 hospitals that offer ORIF in India. The above mentioned hospitals have the required infrastructure and a dedicated unit where patients can be treated. Such hospitals follow all legal protocols and guidelines as specified by the local medical affairs body when it comes to the treatment of international patients.
Accreditation to healthcare providers is given by two bodies in India. One of them is National Accreditation Board for Hospitals & Healthcare Providers (NABH) Standards. A benchmark has been set by National Accreditation Board for Hospitals & Healthcare Providers (NABH). Joint Commission International, a not for profit organization giving certification to numerous healthcare institutions in India and abroad is the other standard.
World-class medical treatment is offered at affordable cost in Indian multispecialty hospitals. These hospitals can do all kinds of surgeries and they have several specialties. In addition to supporting all kinds of specialties, these hospitals even incorporate the general medical needs. Some of the top multispecialty hospitals in India are
India is gaining global attention for medical tourism due to affordable treatment costs and world-class infrastructure. The high end technologies that are at par with the western world and indian hospitals' overall health standards are equivalent to the western world. Indian pool of qualified doctors are highly professional, extremely competent and provide treatment with precision and accuracy. There are several important factors that make India the most favored destination for medical travelers the world over like ease of communication, ease of travel, visa assistance and alternative treatment availability.
Skill and application of that skill with precision ensures that Indian doctors are considered proficient in their work. No matter what new healthcare challenges are present before them, the doctors in India face and overcome them with a lot of confidence. Indian doctors have been educated at the best educational institutions all around the world. You will feel right at home with the best of medical care that Indian doctors and surgeons can provide you with.
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