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.
ORIF cost in Spain varies from one hospital to the other. Some of the best hospitals for ORIF offer a comprehensive package that covers the end-to-end expenses related to investigations and treatment of the patient. Typically, the package cost of ORIF in Spain includes the expenses related to the surgeon's fee, anesthesia, hospital, meals, nursing and ICU stay. There are many things that may increase the cost of ORIF in Spain, including prolonged hospital stay and complications after the procedure.
There are several best hospitals for ORIF in Spain. The top hospitals for ORIF in Spain include the following:
The recovery of the patient many vary, depending on several factors. However, on an average, patient is supposed to stay for about 14 days in the country after discharge. This duration of stay is recommended to complete all the necessary follow-ups and control tests to ensure that the surgery was successful.
One of the topmost destinations for ORIF is Spain. It has a variety of accredited hospital, affordable cost of treatment and some of the best medical fraternity. However, there are other countries as mentioned below that are popular for ORIF as well:
|United Arab Emirates||USD 8200|
|United Kingdom||USD 10500|
There are certain additional cost that the patient has to pay apart from the ORIF cost. The per day cost in this case may start from USD 50 per person.
Some of the cpopular cities in Spain that offer ORIF include the following:
It is possible for patients to opt for video telemedicine consultation before they come for ORIF in Spain. Some of the surgeons offering this service include the following
|Doctor||Cost||Schedule Your Appointment|
|Dr. Joan Carles Monllau||USD 606||Schedule Now|
|Dr. Enric Caceres||USD 606||Schedule Now|
|Dr. Gorka Knorr||USD 530||Schedule Now|
|Dr. Jose Tabuenca Dumortier||USD 311||Schedule Now|
|Dr. Xavier Mir||USD 606||Schedule Now|
|Dr. Manuel Ribas Fernandez||USD 606||Schedule Now|
The patient is supposed to stay at the hospital for about 2 days after ORIF for monitoring and care. During the recovery, the patient is carefully monitored and control tests are performed to see that everything is okay. If required, physiotherapy sessions are also planned during recovery in hospital.
There are more than 8 hospitals that offer ORIF in Spain. The above listed hospitals are approved to perform the surgery and have proper infrastructure to handle ORIF patients. Apart from good services, the hospitals are known to follow all standard and legal guidelines as dictated by the local medical affairs body or organization.
The healthcare accredition standards followed in Spain are very stringent leading to a much needed quality control in the Spanish healthcare sector. The hospitals and healthcare centers in Spain are recognised to be of high quality on various parameters. The international accrediting agency known as JCI accredits hospitals in Spain on patient safety and healthcare quality. Joint Commission International evaluators who judge these hospitals on various parameters are thorough professionals and their results can be completely relied upon.
There is a good number of popular multispecialty hospital groups in Spain that are servicing patients from different hues and backgrounds for a long time. Multispecialty hospital groups in Spain cover a wide network of medical and surgical specialties where treatment is undertaken. We list here some of the best multispecialty hospitals in Spain.
In multispecialty hospital groups in Spain, the scope of treatment possible is really wide at every multispecialty hospital which makes it possible for patients to get treated for a number of conditions under one roof.
The healthcare in Spain is at par with the best in the world and is continuously upgraded with the technologies of today. The doctors in Spain have been found to be adequately skilled and competent in their work at treating different diseases and injuries. There is uni payer healthcare system in Spain that translates to having universal coverage of costs (except those of prescription drugs). You should opt for healthcare in Spain as Spain makes for a good combination of places with a lot of tourist potential and great healthcare facilities.
The doctors in Spain have been educated at the best educational institutions in the world. It is no wonder that the doctors have enriched their knowledge base and refined their skills by hands on experience. The doctors in Spain have a zest for learning and application of new medical and surgical techniques as well as technologies.Whether it is learning new techniques or practical application of the new technologies, the doctors in Spain are adept at it all. Getting your treatment done in Spain should be a seamless affair as there is not even a language barrier with english the second language for many doctors.
When traveling to Spain for your medical treatment please start by creating a checklist for the documents that you need to carry. The medical and travel documents must aid your treatment and journey to Spain as easy and effortless. Travel documents that are essential are financial means proof like bank statement, sponsorship letter, treatment payment proof or proof of your government covering the costs, employment documents (as per status) and passport, visa, roundtrip ticket, travel medical insurance, accomodation proof and civil status proof. Other documents that are required are medical reports, letter from the doctor/hospital referring you for treatment, correspondence between the doctor/hospital that referred you and the one where you are going to get treated and test reports.
Spain is an elite medical tourism destination that has made its mark on the world stage. Spain is synonymous with sporting culture which means that certain fields like sports medicine and orthopaedics are a natural consequence. All sorts of procedures are done in hospitals and clinics in Spain but we are listing the ones most popular for your convenience. Orthopaedic procedures, spine surgery, sports medicine related procedures, fertility treatments, plastic surgery, dentistry, eye care and bariatric surgery.
The vaccinations before you head to Spain as a medical traveller are not just essential but mandatory as well. Routine vaccines before going to Spain are Chickenpox (Varicella), Diphtheria-Tetanus-Pertussis, Flu (Influenza), Measles-Mumps-Rubella (MMR) and Polio. Vaccinations for Measles, Hepatitis A and Hepatitis B are taken by travellers who are at a higher health risk. Please get vaccinated for Meningitis, Shingles, Pneumonia, Covid19 and Rabies before traveling to Spain.
Hospitals in Spain provide facilities that make the treatment journey smooth for medical travellers everyday. In line with this endeavour, international patient services are available in major hospitals in Spain. As a medical traveller, one positive is the opportunity of availing private healthcare insurance in hospitals in Spain. Hospitals in Spain provide many additional facilities as well such as:
Spain is well known for its various medical tourism destinations such as
Barcelona has advanced child healthcare hospital facilities whereas Madrid is known for general health and reproductive healthcare. There is a focus on investments in the medical tourism field in Spain in a futuristic attempt to drive growth in the sector. Medical infrastructure in Spain is highly developed and is being regularly upgraded with the latest technologies.
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