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What Is the Difference Between Open Reduction and External Reduction of a Fracture?

Updated on December 10, 2010
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Barbara worked at Thomas Hospital Home Health and was certified for home health from ANCC. She received her MSN from Mobile University, AL.

external fixation of a fracture
external fixation of a fracture | Source

What Is The Difference?

As a home health nurse many patients have had surgically repaired fractures for one reason or another. Not only does it depend on where the fracture occurs but how best to treat the patient for the best outcome.

The most well known of fractures are hip fractures and sometimes, if both the long bone of the thigh, the femur, as well as the hip joint itself are involved an entire hip replacement will be done. This article is not about total hip replacements. Rather, it is about the difference between an Open Reduction Internal Reduction and an External Reduction of a fracture.

First we need a bit of background. Whether called a break or a fracture or a hairline all of these terms mean the bone is out of line; therefore it is broken and the worst case scenario of not having a broken bone repaired is an infection of the bone itself known as osteomyelitis. That is the worst case of course, not necessarily the most common. Most common results of not having a broken bone repaired is loss of function, obvious malformation of the bone and inability to use the limb involved with the break.


ORIF versus External Fixation

Open means the orthopaedist has to open the skin and muscles and tendons to get at the broken bone

Reduction means the orthopaedist has to realign the broken bones; put them back together.

Internal means it is done inside the body.

Fixation means something metallic is used to make the broken bone stay together. This means that plates and screws are used after the bones are realigned. Afterwards all that is seen on the outside of the body is the incision line. Sometimes staples are used, sometimes sutures and sometimes just a sterile cement that holds the layers of the outside skin together. Physical therapy and time are needed to help with the healing process.

Picture two shows the ORIF and how the plates and screws are now holding the broken bones in place.

External means whatever is done to realign the broken bones has been done from the outside of the body without an incision.

Fixation means something metallic is used to make the broken bone stay together. Again something is placed through or onto the broken bone to hold it in perfect alignment until it fully heals. Usually this means a rod is placed through the broken bone itself until it is fully healed. These rods must be kept cleaned several times a day and the skin must be kept from growing attached to the rod itself. Usually all this entails are sterile cotton tipped applicators and half hydrogen peroxide half normal saline. The applicator must be rubbed around the ouside of the rod to keep the rods clean and to keep the skin from growing over the rod itself.

Periodically during the healing process the othorpaedist may have to tighten the rods and take follow up x-rays of the broken bone. Once the bone is fully healed the rods are removed from the body. After the rods are removed then physical therapy is usually ordered to help improve the strengthening of the muscles and increase functional ability.

Both of these surgeries are done with the patient under anaesthesia of some kind. Usually it is done with the x-ray in the same room or close enough to be wheeled into the room to be sure the plates, screws or rods are holding the broken bone in the best place.

Although both of these surgeries may sound intensive they are both used successfully and often in several different types of fractures. Orthopaedists and their teams of trained nurses and therapists are there to make sure that if you ever need them, they will be there to help you and to get you back to your full capacity as soon as possible.


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    • RNMSN profile image

      Barbara Bethard 7 years ago from Tucson, Az

      thats what mean ole nurse kratchets are for don't ya know LL Woodard :)

      thank you and love to you!

      barbara b

    • L.L. Woodard profile image

      L.L. Woodard 7 years ago from Oklahoma City

      Being able to understand procedures such as these with easy-to-understand explanation de-mystifies the process and hopefully allows the person involved to experience less emotional stress.