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Pilon fractures can turn your life upside down instantly—I know because I've been there. If your doctor has recommended ORIF surgery, find in this post what it is, what to expect, and how to navigate recovery.
ORIF stands for Open Reduction Internal Fixation, which means the surgeon makes an incision to realign your broken bones (open reduction) and secures them with plates, screws, or rods (internal fixation).
In some cases, simpler fractures can be treated with a closed reduction, where the bones are realigned without surgery. However, pilon fractures are typically too severe for this method.
ORIF is often the best option for complex fractures like pilon fractures because it gives stability and helps the bones heal in the correct position.
Some pilon fractures require external fixation as a temporary step before ORIF surgery to stabilize the fracture, reduce swelling, and let soft tissues heal before the internal fixation can be done safely.
Before ORIF surgery, your medical team will give you instructions on how to prepare for the surgery.
You'll likely be told to fast for 8 to 12 hours beforehand to make sure your stomach is empty before anesthesia. Your doctor will likely order a pre-operative evaluation from your PCP, pre-operative blood work, and imaging (like X-rays or CT scans). If you take medications—like blood thinners, NSAIDs, or supplements—you may need to stop or adjust them the days before.
You'll also want to manage your swelling, which can increase the risk of complications. Keep your leg elevated above heart level as much as you can. If your pilon fracture is particularly unstable, you might already have an external fixation device to keep the bones aligned and reduce swelling.
During ORIF surgery, you'll be under general anesthesia, meaning you'll be completely asleep and won't feel anything. An anesthesia provider will monitor your vital signs like heart rate, blood pressure, oxygen levels, and breathing to make sure you are safe during surgery.
Your orthopedic surgeon will make an incision(s) to access the fracture, carefully realign the broken bones, and secure them with metal plates, screws, or rods to hold everything in place.
The length of the procedure can vary depending on the complexity of the fracture—while most surgeries take around 2-3 hours, more severe cases, like pilon fractures, can take 5 hours or longer (like mine). After surgery, you'll wake up in a recovery area where your medical team will monitor you and manage any immediate post-anesthesia effects.
After surgery, your incision(s) will be carefully closed with stitches or staples, and a dressing will be applied to protect the wound(s) and reduce the risk of infection. Depending on your fracture, your leg may be placed in a splint or cast to keep it immobilized.
After ORIF surgery, many patients are discharged the same day, but you'll need someone to drive you home and get you settled. You'll be sent home with instructions for managing pain, which usually means oral pain medicines and keeping your leg elevated.
Your doctor may also prescribe anti-nausea or anti-constipation drugs since strong prescription pain medication, like opioids, often causes side effects such as nausea or constipation.
You'll be instructed to avoid putting any weight on the injured leg, probably for 6 to 12 weeks, depending on the complexity of your fracture. Following your surgeon's non-weight-bearing guidelines is super important to make sure the surgical repair heals correctly.
The initial follow-up visit after ORIF surgery typically happens around 1-2 weeks to remove your splint or dressing, check the incision site, and, if you had staples or stitches, take them out. This follow-up is a chance to ask questions and review the next steps, like when you might start physical therapy.
My splint was removed two weeks after surgery. X-rays and incisions were looking good so they took out the sutures, replaced them with adhesive surgical tape strips (Steri-Strips), and sent me home in a walking boot (not yet to be walked on). To me, the weirdest symptom in the immediate weeks after surgery was how dry my foot and leg were.
Gentle physical therapy may be recommended soon after surgery, but it depends on the specifics of your injury and your surgeon's recovery protocol. Early movement is often encouraged to prevent joint stiffness, improve circulation, and maintain range of motion, but some people may need more time to heal before beginning these exercises.
My surgeon had me start doing knee bends five times a day for 20 minutes after my two-week follow-up.
Swelling, stiffness, and discomfort will continue to be challenges in the long term, but staying consistent with your recovery plan and using assistive devices like crutches or a knee scooter can make the process smoother.
Like any surgery, ORIF comes with risks like infection, irritation from the hardware, delayed bone healing, nerve damage, or even longer-term problems like post-traumatic arthritis. Most immediately, keep an eye out for signs of infection (redness, warmth, increasing pain, or discharge from the incision site), and let your doctor know right away if something doesn't seem right.
There are plenty of ways to support your healing and stay on track. First, focus on nutrition—your bones need calcium and vitamin D to repair, so try to include foods like dairy, leafy greens, salmon, and fortified cereals in your meals. Staying hydrated and eating a balanced diet can also help your body recover.
The right tools can make a big difference in your daily comfort and mobility. Crutches or a knee scooter can help you get around without putting weight on your leg, while a shower chair or removable cast cover can make bathing easier and safer.
Keeping a positive mental attitude is just as important—recovery can feel slow (trust me), but pushing yourself to reach small goals and celebrating milestones (like being able to wiggle your toes again) can keep you motivated.
Lean on friends, family, or even online support groups like Pilon Fractures Suck! when you need encouragement—we've been there too.
