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 cost of ORIF in the United Kingdom starts from $10500. In the United Kingdom, ORIF is conducted across many multispecialty hospitals.
ORIF cost in the United Kingdom varies from one hospital to the other. 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 the United Kingdom includes the expenses related to the surgeon's fee, anesthesia, hospital, meals, nursing and ICU stay. Post-surgical complications, new findings and delayed recovery may have an impact on the total ORIF cost in the United Kingdom.
There are many hospitals that perform ORIF in the United Kingdom. The following are some of the most renowned hospitals for ORIF in the United Kingdom:
While the speed of recovery may vary from patient to patient, they are still required to stay for about 14 days 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 the United Kingdom. It has a variety of accredited hospital, affordable cost of treatment and some of the best medical fraternity. 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. The extra charges may start from USD 50 per person.
The following are some of the best cities for ORIF in the United Kingdom:
The patient has to spend about 2 days in the hospital after ORIF for proper recovery and to get clearance for discharge. 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 1 hospitals that offer ORIF in the United Kingdom. These clinics have propoer infrastructure as well as offer good quality of services when it comes to ORIF These hospitals comply with all the rules and regulations as dictated by the regulatory bodies and medical association in United Kingdom
The healthcare systems in the United Kingdom receive accreditation from QHA Trent and United Kingdom Accreditation Forum. QHA Trent is an independent holistic accreditation organization that is dedicated to improving quality and reducing risks for healthcare providers, patients, and the general public. There is a strong quality framework to ensure the performance of healthcare systems. Various inspection and improvement processes are merged with accreditation programs and regulatory bodies to provide a common mechanism for quality improvement. KOIHA has a strict procedure for evaluating the healthcare system based on administrative management, quality of patient care, and performance management.
The United Kingdom is considered one of the leading destinations in the world for seeking treatment due to its modern infrastructure and major medical advancements. The country has reported steep growth in the medical tourism sector in the last few years and this trend is set to rise further as the country is extensively investing in technology and communication and transport. The United Kingdom’s healthcare system has received worldwide recognition due to some unique aspects like appointments and same-day diagnosis, rapid response multi-disciplinary review teams, and emerging treatments. Populated with state-of-art hospitals like London Bridge Hospital, BUPA Cromwell, and Great Ormond Street, the country boasts of world-class treatment through highly trained doctors and advanced technology.
The United Kingdom boasts of a large pool of world-class doctors who are much competent and skilled in their specialty area. They have to undergo mandatory rigorous training to achieve the highest level of excellence in their niche. The country boasts of having high-quality doctors of internal standards and most of them have received education at reputed institutions. The doctors perform some procedures like knee replacement, gallbladder removal, and hip replacement with a high success rate, ensuring complete patient safety and speedy recovery. The United Kingdom is also known to have world-class gynecologists, orthopedic doctors, cardiologists, and neurologists who have reported high success rates through their holistic approach of treatment.
A candidate willing to visit the United Kingdom for medical treatment needs to check whether he needs a medical visa or not because people from some countries are allowed without a visa. Electronic UK visa waiver program is available for countries like Kuwait, Oman, Qatar, and United Arab Emirates. The documents required for applying for a medical visa include:
You are allowed to extend your visa by 6 months in case you need further treatment.
United Kingdom is one of the major medical tourism destinations with a large pool of state-of-art hospitals. Some of these hospitals are:
Equipped with all modern facilities, the hospitals offer a large number of procedures in modern surroundings, supported by well-trained doctors. Several other factors make these hospitals popular, such as a wide variety of food options, patient-centric care, low mortality rate, and high success rates, efficiency of doctors and other healthcare staff, and safety aspects. You can check a few ratings and rankings systems to find the best hospitals in the United Kingdom. The Royal Berkshire NHS Hospital holds first position in the United Kingdom and ranked at 67 in the world. You can also check inspection ratings of the Care Quality Commission (CQC), an independent regulator of healthcare.
The United Kingdom has received worldwide recognition for its excellence in procedures like:
According to a report by BAAPS, breast reduction and breast augmentation are the most popular procedures in the country. With recent developments in cancer care technology, the United Kingdom has been recognized as a leading country for effective cancer treatment. Many people prefer the United Kingdom for hip replacement because of well-trained orthopedic surgeons, speedy recovery, and the latest techniques.
The most popular cities that are preferred by medical tourists in the United Kingdom are:
Edgbaston Medical Quarter in Birmingham offers some of the best places for treatment, particularly in trauma, oncology, diabetes, and fertility and has become the most visited place for medical tourists to seek treatment. Birmingham, which attracts a large number of international patients for treatment, has modern infrastructure, better connectivity, highly trained doctors, and top hospitals. London is the epicenter of medical tourism which attracts people from different parts of the world. It is the largest city in the United Kingdom, which is populated with quality hospitals like Chelsea and Westminster Hospital, St Mary’s Hospital, and The Royal London Hospital.
Yes, vaccines are recommended or required for the United Kingdom. The CDC and WHO recommend the below vaccines for the country:
For effective immunization, a person should get vaccinated at least 8 weeks before the date of travel. In case you are suffering from a medical condition that restricts you from vaccination, you can be exempted from vaccination after a medical practitioner confirms the condition. You should keep yourself updated with a travel advisory issued by the government for complete information on vaccination.
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