Distal Radius ORIF Info Consent
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Video transcript
The distal radius is the main bone of the wrist, and a break here is the most common fracture of the upper limb. It usually happens from a fall onto an outstretched hand, whether a slip from standing height, or a higher-energy injury like a fall from a bike. The wrist becomes painful, swollen, and sometimes visibly out of shape. In younger people it usually takes a bigger impact, while in older people it can happen from a simple fall, and may be the first sign of thinning bones. An X-ray confirms the break, and shows whether the pieces have shifted. Whether a broken wrist needs surgery depends mainly on whether the pieces are out of position, and whether they stay put. Stable, well-aligned fractures heal in a moulded cast over four to six weeks, with X-rays along the way to check the position holds. If the wrist is badly out of shape at the start, it is usually straightened early, with the area numbed. Surgery is offered when the break is displaced or unstable, when it extends into the joint surface, or when getting moving earlier matters. In older patients, a bone-density check is often arranged afterwards, because treating thinning bones helps prevent the next fracture. The operation fixes the break with a low-profile metal plate and screws, placed through an incision on the front of the wrist. The pieces are realigned, and the plate holds them in position while the bone heals, with X-ray imaging in theatre confirming the position. The operation usually takes around sixty to ninety minutes, under a regional or general anaesthetic, as a day or overnight stay. The plate sits deep under the muscle, and usually stays in for good without you noticing it. The aim is a wrist that heals straight, and gets moving sooner. A removable splint protects the wrist for around two weeks, and gentle movement starts early, guided by a hand therapist. Light desk work usually resumes at around two weeks. Driving waits until you are out of the splint, and can control the wheel safely, typically four to six weeks. Heavier lifting and manual work are held off until around twelve weeks, when an X-ray usually confirms the bone has fully joined. Getting moving early is the rule after this kind of fixation, and most wrists regain very useful movement and strength over the following months.
Open reduction and volar plate fixation of the distal radius — operation, recovery, rehabilitation.
Why this operation has been suggested
Your surgeon has suggested open reduction and internal fixation, also known as ORIF, to repair a broken bone in your wrist using a metal plate and screws. This surgery is typically offered to adults with complex fractures where the bone has shifted out of place or broken into multiple pieces. While non-operative options like casting are tried first, surgery is recommended when those methods cannot provide enough stability or healing.
The main goal of this operation is to restore the normal shape of your wrist joint and allow you to move your hand sooner. Evidence shows that using a plate offers the best results for early and sustained recovery compared to other methods. It also significantly reduces the risk of complications related to the bone failing to heal properly.
Before the operation
Please fast for six hours before your surgery and stop any blood-thinning medicines as your surgeon advises. Arrange for someone to drive you home and bring a list of all your current medications. You will likely need X-rays, and possibly an MRI or blood test, to check your bone and joint health before the procedure. Your surgeon will perform an open operation through a standard incision to realign the bone and secure it with a plate. Sometimes, a small camera is used inside the joint to ensure the alignment is perfect. Wear comfortable clothing and arrive ready for your anaesthetic review.
On the day
You will arrive at the hospital and meet your surgeon and the anaesthetist. This operation is done under general anaesthetic. You will be fully asleep for the operation. Some patients may also have a regional nerve block for post-operative pain relief — the anaesthetist decides on the day based on your individual circumstances.
You will then go to the operating theatre where your surgeon makes a cut in your skin to reach the bone. They use a metal plate and screws to hold the broken pieces in place. After the surgery, you will wake up in recovery while nurses watch over you and manage your pain.
What the operation involves
Your surgeon will make a single cut over the wrist to reach the broken bone. This is an open approach, meaning the area is fully exposed rather than using small keyhole cameras. Through this opening, your surgeon carefully moves the broken bone pieces back into their correct position.
Once the bone is aligned, your surgeon secures it using a metal plate and screws. This method offers the best results for early and sustained recovery and helps reduce healing complications. The plate is placed along the side of the radius bone to hold everything steady while it heals. In some cases, your surgeon may use a special screw technique with any locking plate that has options in the shaft.
After the bone is fixed, your surgeon closes the cut with stitches. You may need a second small surgery later if the hardware causes irritation, as there is a 28% chance hardware removal may be required for patients undergoing this plating. Early movement of your hand and wrist is encouraged after the operation to help you regain function sooner than if you waited.
After the operation
You will wake up in a recovery ward where your pain is managed with general medicine. Your arm will be in a sling or brace with a dressing over the incision. Your surgeon made an open cut to fix the bone, sometimes using a small camera to check the joint. You can start moving your fingers and wrist early to help your function. Most people go home the same day, but some stay overnight. You must have someone stay with you for the first 24 hours.
Recovery
You will likely feel pain and swelling in your wrist and hand during the first few days. This is normal as your body heals from the surgery. Your surgeon may use a plate and screws to hold the bone in place through a small cut on your wrist. You might also have a brace or cast to protect the area while you rest.
Early movement is key to getting your hand back to normal. Your physiotherapist will guide you through gentle exercises to reduce stiffness. You will wear a sling or brace when moving around, but you should start moving your fingers and elbow as soon as you are able. These small movements help your hand feel better much sooner than waiting too long.
As the swelling settles, you will notice your grip and daily tasks becoming easier. You can return to light home activities once your surgeon clears you to do so. Your timeline may differ from others, so follow the specific advice from your surgeon and physio team. They will help you know exactly when to increase your activity level safely.
What can go wrong
Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.
Sometimes the metal hardware used to hold your bone in place becomes uncomfortable or causes irritation. If you feel pain or pressure over the plate, you might need a second small procedure to remove it. This happens in about one out of every four patients.
You may notice that your wrist does not move as smoothly as expected. Early movement helps your hand work better sooner than waiting too long. If your wrist feels stiff or weak, tell your surgeon right away so they can guide your therapy.
In some cases, the bone alignment might shift slightly over time. This can happen if the screws are not placed deep enough into the bone. If you feel a new clicking sound or notice your hand looks different, bring it up at your next check-up.
Overall, serious problems are rare. Most people who have this surgery recover well with early movement and careful follow-up. The complications table on this page lists typical rates if you want the specifics.
When to call us
Call us if you have a fever, increasing redness, or drainage from your incision. Go to emergency if you feel sudden severe pain, notice your calf is swollen, or have trouble breathing. Call immediately if you lose feeling in your fingers or cannot move your hand. These signs need urgent assessment to protect your recovery.
