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.
The ORIF package cost in Morocco varies from one hospital to another and may offer different benefits. There are many hospital that cover the cost of pre-surgical investigations of the patient in the treatment package. Typically, the package cost of ORIF in Morocco includes the expenses related to the surgeon's fee, anesthesia, hospital, meals, nursing and ICU stay. Extended hospital stay, complications after the surgery or new diagnosis may affect the overall cost of ORIF in Morocco.
There are several best hospitals for ORIF in Morocco. Some of the best hospitals for ORIF in Morocco include the following:
Upon discharge from the hospital after ORIF in Morocco, the patients are advised to stay for about 14 days for recovery. This period is important to conduct all the follow-up tests to ensure that the surgery was successful and the patient can go back to the home country.
Morocco is undoubtedly one of the best countries for ORIF in the world. It offers the best medical expertise and good patient experience at an affordable cost. However, there are other countries as mentioned below that are popular for ORIF as well:
|United Arab Emirates||USD 8200|
|United Kingdom||USD 10500|
Apart from the cost of ORIF, the patient is also required to pay additionally for daily meals and guest house accommodation. These charges starts from USD 50 per person.
ORIF in Morocco is offered in almost all metropolitan cities, including the following:
After the ORIF takes place, the average duration of stay at the hospital is about 2 days. The doctors team review the patient's recovery during this time with the help of blood tests and imaging scans. Once they feel that everything is on track, the patient is discharged.
There are more than 1 hospitals that offer ORIF in Morocco. The above listed hospitals are approved to perform the surgery and have proper infrastructure to handle ORIF patients. Also, these hospitals follow the necessary guidelines as required by the medical associations for the treatment of ORIF patients.
The hospitals in Morocco are as good as the best hospitals in the world in every parameter and thus JCI accreditation has been given to many wonderful hospitals in Morocco. The topmost healthcare accreditation body in the world with long term experience, Joint Commission International has gold standard credibility in Morocco. Premier healthcare organisations are competing for an accreditation by Joint Commission International, the most sought after in the field. The organisation management standards, patient care levels and quality of service is measured through JCI accreditation.
Let us look at the popular multispecialty hospitals in Morocco:
The popular multispecialty hospitals in Morocco are equipped with cutting edge equipments which are constantly upgraded. There are many multispecialty hospitals and clinics in Morocco that are present in the cities of Fes, Marrakech, Casablanca, Tangier and Rabat. The government and private organisations in Morocco are focused on providing the best in healthcare through its healthcare ecosystem comprising of multispecialty hospitals and clinics.
In Morocco, healthcare has a huge base with clinics giving basic healthcare facilities and local, regional as well as university hospitals providing advanced facilities. It is wise to head to Morocco as a medical traveller as you can get your medical treatment and visit the tourist places at one go with its wonderful healthcare structure. The technological push by the government and private sector in healthcare infrastructure is another reason for you to go to Morocco for your medical treatment. It is not just the short waiting times but the ease with which you can get your medical visa, travel and ensure hospital transfer that make Morocco a medical travel hotspot.
It speaks to the good quality of doctors in Morocco that not only are they good in treating every kind of medical condition of the patients but are also good in dealing with exigent emergencies with ease and success. It is the excellent education and long term experience of doctors and surgeons in Morocco that speaks to their skill in treating patients. The best results are achieved by the doctors in Morocco by applying new techniques and working with the most advanced technologies. The international experience of the doctors in Morocco comes not just from their international medical centers of the world but also due to their experience of treating patients from various countries.
The essential documents that you must carry along on your journey to Morocco are:
Please ensure that the documents support your international, local travel and transfer and are a testament to your ability to pay for your medical travel. Your medical travel to Morocco should be supported with clear and concise communication between your healthcare providers (country of origin and Morocco). A complete set of healthcare and travel documents are an enabler in your medical travel to Morocco.
There are several popular procedures that are being completed with successfully in Morocco, some of which we have listed here for your convenience:
Cosmetic surgeries such as Breast Augmentation and Liposuction are routinely performed in the hospitals and clinics in Morocco. Even in the specialties such as Gynaecology, the hospitals and clinics in Morocco are doing really well in terms of high success rates and increasing number of patients.
If you are traveling to Morocco for your medical treatment, you wish to be adequately prepared in the form of vaccinations, so it is not just mandatory but an intelligent decision to be vaccinated beforehand. There are a number of recommended travel vaccinations (by CDC and WHO) to Morocco as listed below.
The right dosage and the frequency of vaccines should be decided post consultation with your healthcare provider basis your age and health conditions. MMR, DPT and Flu are considered as routine vaccines by CDC or Centers for Disease Control and Prevention and WHO or World Health Organisation.
The treatment, travel and transfer process is made easy when you are undergoing medical treatment in any multidisciplinary hospital in Morocco through the International patient centers. Please find below some of the other facilities that are present in the hospitals in Morocco.
Whether it getting the right insurance coverage or the payment process, you can get all the assistance at the hospital in Morocco." The virtual consultation via mediums like calls, emails and video is a convenient way of conversing with your physician in the hospital in Morocco.
Please find below some of the medical tourism destinations in Morocco:
Medical tourism in Morocco is on an upswing and has a promising future because of the proposed investments by the private sector and the Government of Morocco. In Medical Tourism Index 2020-21, Morocco has a good ranking of 31st which denotes its rising status in the medical travel field. In addition to development of a medical tourism ecosystem, the Government of Morocco has worked in the direction of adequate legislation to support the industry.
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