Open Reduction and Internal Fixation of an Arm Fracture in Children

What is open reduction and internal fixation of an arm fracture?

Open reduction and internal fixation (ORIF) is surgery to fix a fractured (broken) bone. The upper arm bone is called the humerus. The two bones of the forearm (below the elbow) are called the radius and ulna. Your child may have broken his arm in a car crash, while playing sports, or by falling on his arm while it is extended. If a child's arm is twisted or hit by another person, it may break.

ORIF surgery may be done when one or more arm bones are broken or dislocated (moved out of place). With an open reduction, caregivers move the bone back into place during surgery. Internal fixation means that hardware (metal objects) are used to hold your child's bone together. Your child may need ORIF if caregivers did a closed reduction, but the bone did not heal. An ORIF is also done if a bone is broken into many pieces or there is bone sticking out of the skin. ORIF surgery may decrease your child's arm pain and help his broken arm heal correctly.

What happens during my child's open reduction and internal fixation surgery?

Your child will be given medicine called general anesthesia or local anesthesia. General anesthesia makes your child sleep during his surgery. Local anesthesia numbs the surgery area. Your child also may get monitored anesthesia, which will make him feel sleepy. Caregivers clean your child's arm and then make an incision (cut) in the skin over the broken bone. A tool is used to spread the arm muscles so that caregivers can see the broken bone. Damaged tissue or bone that cannot be fixed may be removed from your child's arm.

Your child's caregiver will move the arm bone into the correct place. Hardware (such as a metal plate) is used to hold the pieces of your child's bone together. The plate may be held to your child's bone with screws, pins, rods, or wires. X-rays are taken after the hardware is attached to your child's bone. Your child's caregiver will close the skin with stitches or staples. A cast or splint will be put on your child's arm to keep it straight while his bone heals.

How do I care for my child after his open reduction and internal fixation surgery?

Activity:
After surgery, your child will not be able to use his arm for activities such as lifting. Your child may not be able to play sports until his bone has healed. Ask caregivers to tell you what activities are best for your child while his arm heals. A caregiver called a physical therapist may help your child with exercises. These exercises may help strengthen his arm during and after it heals. Ask caregivers when your child may return to school.

Bathing and cast or splint care:
If you have a young child, ask caregivers how to bathe him.
Do not
let his cast or splint get wet until caregivers say it is okay. Ask caregivers for more information about how to take care of your child's cast or splint.

Ice and heat:
Ice and heat may help decrease swelling and pain in your child's arm. Ask your child's caregiver when and how to put ice or heat on your child's arm.

What are the risks of open reduction and internal fixation surgery on the arm?

During surgery, your child may bleed too much and need a blood transfusion. Your child may be allergic to anesthesia medicine and have trouble breathing. He may have nerve damage and lose feeling in his arm. After surgery, he may get an infection in his wound (surgery area). The hardware in his arm may loosen and move out of place. He may have pain, swelling, or trouble moving his arm. His arm may not heal or it may break again in the same place. He may get compartment syndrome (increased pressure in his arm), which can damage muscles and tissue. If your child is still growing, his broken arm may not grow as long as his other arm. Your child may get a blood clot that causes serious problems, such as a stroke, and he may die.

If your child does not have surgery, his arm may not heal. He may have pain and trouble moving or using his arm. His arm may not grow as straight as it should. Your child could lose feeling in his arm, or his blood vessels may be damaged. There may be dead tissue in his arm, which can cause a serious infection. Call your child's caregiver if you have questions or concerns about his ORIF, medicine, or care.