Complications of ORIF Ankle Surgery

The abbreviation; O.R.I.F. stands for Open Reduction/Internal Fixation. This refers to a variety of open orthopedic surgical techniques where broken bones in the ankle are repaired using various devices to restore the bones to normal position and alignment, thus optimizing healing. The devices commonly used include metallic screws, pins and plates. As good as surgical techniques and fixations are these days, ankle fractures, together with open reduction and internal fixation, can have complications from the use of the fixation devices and from the injury itself.

Is This an Emergency?

If you are experiencing serious medical symptoms, seek emergency treatment immediately.


Surgical wound infection is one of the most common complications of any surgery. It becomes even more dangerous when the infection occurs at or within bones. An article published in the "Journal of Materials Science" online in October 2009 stated that musculoskeletal infection, which is infection of the bones and muscles, is one of the most common complications associated with fracture fixation surgery.

Microorganisms, typically colonized on the fixation devices themselves, such as plates, screws and pins, combine with the formation of a membranous bio-film that can resist antibiotic penetration to create considerable difficulty in treating the infection.

If these microorganisms invade the bone via channels formed by pin and screw holes, the resultant infection is called osteomyelitis. This can be catastrophic and cause lengthy healing, abscess formations and bone and tissue destruction.

Painful Retained Hardware

Another potential complication of ankle fracture surgery is the development of painful retained hardware. Because there is little subcutaneous fat between the skin and various bony prominences of the ankle, fixation devices such as screws and plates inserted in these areas can become uncomfortable as they can protrude under the skin and become sensitive pressure areas. One of the most common areas for this problem to occur is along the lateral, or outer, portion of the ankle called the lateral malleolus, which is made up of the distal, or end, portion of the fibula. Fixation devices easily protrude under the skin and can rub against shoes and boots, causing pain.

An article published in the "Journal of the American Academy of Orthopedic Surgeons" concluded that fixation removal merely for pain relief is not always a guaranteed symptom eradicator 1. The study evaluated thirty-nine patients, twenty-two of whom had hardware removal for pain symptoms. Only 50 percent had relief, concluding that hardware removal should not be performed merely for pain relief, and that careful consideration should be made as to expected outcomes before undergoing the procedure.

Non-Union/Failure to Heal

Any open reduction/internal fixation procedure, not just in the ankle, carries a statistical risk of developing a condition known as a non-union. A non-union develops when the opposing edges of a fracture fail to heal. This typically occurs from the situation where the edges of the fracture fragments are too far apart to heal properly, or there is too much micro-motion occurring at the fixation site to prevent solid healing. The resultant disruption in blood supply can cause the bone edges to not heal or to form a soft fibrous attachment instead of solid bone formation.

Post Traumatic Arthritis

When an ankle fracture involves joint surfaces, the risk of developing degenerative arthritis is greatly elevated. According to a May 2007 article in the "Journal of Orthopedic and Sports Physical Therapy," post traumatic arthritis is the most common form of arthritis to affect the ankle.

Post-traumatic arthritis develops when the normally-smooth joint surfaces become damaged and irregular. When fixing an ankle fracture that has disrupted joint surfaces, it is critical that these surfaces be restored to as normal as humanly possible to minimize arthritis development.