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Orthopaedic trauma · UK

Open reduction internal fixation, by a specialist trauma surgeon.

The workhorse of orthopaedic trauma - a fractured bone realigned under direct vision and held with plates, screws, wires or a rod. Planned on CT, delivered on AO principles, rehabilitated properly.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private ORIF surgery costs in the UK.

Indicative ranges across UK private providers. Cost depends on the fracture, the implants, theatre time and length of stay.

In short

£8,000–£16,000, home within 1–2 nights.

Procedure Indicative range
Wrist ORIF (distal radius, volar plate) £8,000–£14,000
Ankle ORIF (bimalleolar / trimalleolar) £9,000–£16,000
Proximal humerus ORIF (PHILOS plate) £12,000–£20,000
Tibial plateau / pilon ORIF £15,000–£25,000
Complex articular / periprosthetic ORIF £18,000–£30,000
Consultation + planning CT review £300–£500

Prices vary by hospital, by the surgeon, by the implants chosen and by the length of stay. Trauma delivered via the NHS is free at the point of use.

The problem

The right surgeon, the right operation, the right centre.

Fracture surgery done well is boring in the best way - the X-rays look anatomic, the wound heals, and you get back to your life. Done badly, it costs you a joint. The surgeon and the plan matter more than the metalwork.

  • Not sure ORIF is needed?

    Some fractures are better in a cast, or with a nail, MIPO or percutaneous screws. We say so before you agree to open surgery.

  • Worried about the surgeon?

    A named consultant orthopaedic trauma surgeon who does your fracture pattern often - not a generalist, not a trainee.

  • Want it planned properly?

    CT-based planning for articular fractures, implants chosen per pattern, physiotherapy started day one.

When it helps

When ORIF is the right operation.

The AO indications we see most - plus the one red flag that means A&E right now, not a clinic appointment.

  • Displaced articular fracture

    A fracture that runs into a joint surface (ankle, wrist, tibial plateau, elbow) and needs anatomic reduction to protect the joint long term.

  • Unstable fracture pattern

    A fracture likely to slip out of position in a cast - spiral, comminuted, or with poor bony contact.

  • Failed closed reduction

    A fracture that could not be held with a cast or splint and has re-displaced on follow-up imaging.

  • Polytrauma, needs early mobilisation

    Multiple injuries where stable internal fixation lets you sit up, transfer and rehabilitate rather than lie flat.

  • Non-union or malunion salvage

    A fracture that has not healed, or has healed in the wrong position, needing take-down, realignment and re-fixation.

  • Pathological fracture

    A fracture through diseased bone (metastasis, cyst) where fixation stabilises the bone and controls pain.

  • Periprosthetic fracture

    A fracture around an existing hip, knee or shoulder implant - planned with the original prosthesis in mind.

  • Red flag: open fracture or compartment syndrome

    Bone through skin, or a swollen, painful limb that is losing sensation, is a same-day A&E emergency - not a clinic booking.

Procedure options

ORIF is one option, not the only one.

What each option on the table actually involves - and which fracture pattern each one suits.

  • Open reduction + plate/screw fixation

    The workhorse. Meticulous exposure, anatomic reduction of the joint surface, definitive plate + screw construct. Locking, buttress or anatomical plates.

  • Intramedullary nailing

    For long-bone diaphyseal fractures (femur, tibia, humerus). A rod down the medullary canal - less soft-tissue stripping, early weight-bearing.

  • MIPO (minimally invasive plating)

    Small incisions, plate slid under the muscle, screws percutaneously. Preserves soft tissue and periosteum. See our MIPO guide.

  • Percutaneous screw fixation

    For scaphoid (Herbert/Acutrak), femoral neck (cannulated screws in situ), or as supplementation for a tibial plateau.

  • K-wires + tension band

    For olecranon, patella, some hand and wrist fractures. Simple, cheap, biomechanically sound for the right pattern.

  • External fixation

    For open fractures, damage control in polytrauma, or as a temporary bridge before definitive internal fixation once soft tissues settle.

  • DHS / cannulated screws (hip)

    For a young patient with a femoral neck fracture - in-situ fixation to preserve the native head where possible.

  • Closed reduction + cast

    For stable, undisplaced or well-reduced fractures. Not everything needs surgery - a good trauma surgeon will say so.

Safety and complications

The risks, honestly - and how we reduce them.

Bony union rates of 90–95% at 6–12 months are typical for well-selected, well-fixed fractures. These are the things that can still go wrong, and what changes the odds.

  • Non-union (5–15%)

    Bone that does not heal - higher in smokers, diabetics, open fractures and the tibia. Nutrition, smoking cessation and stable fixation reduce risk.

  • Malunion (angular or rotational)

    Healing in the wrong position - matters most for joints and long-bone rotation. Careful intra-op reduction is the defence.

  • Infection (2–5% closed, 10–30% open)

    Risk climbs sharply with Gustilo III open fractures. Timely antibiotics, wash-out and soft-tissue cover are critical.

  • Hardware failure or symptomatic metal

    Screws can loosen, plates can break. 10–30% of patients want their metalwork out at 12–18 months after union - a separate day-case.

  • Nerve injury

    Radial with humerus, superficial peroneal with fibula, common peroneal with tibia, sural with ankle. Usually neuropraxia and recovers.

  • DVT / PE

    Real risk after limb trauma and surgery. Routine LMWH prophylaxis, early mobilisation and mechanical devices reduce it substantially.

  • Compartment syndrome

    A surgical emergency in the tibia and forearm. Rising pain out of proportion, tight compartments - same-day fasciotomy if it happens.

  • Post-traumatic osteoarthritis

    The long-term price of articular fractures. Anatomic reduction is the single biggest thing that reduces the risk.

  • Red flags after surgery

    Fever, spreading redness, wound discharge, a swollen calf, sudden breathlessness, or worsening pain in a splint - call the team or A&E the same day.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever construct was used, the note the trauma surgeon sends you keeps to the same shape.

A UK consultant orthopaedic trauma surgeon reviewing a patient’s operation notes

A quiet reminder

AO/OTA language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your fracture-clinic review, just ask.

  1. 01 Header

    Fracture pattern and classification

    The bone, side, AO/OTA classification (or Weber/Neer where relevant), whether it is open (Gustilo grade) and the mechanism.

  2. 02 Technique

    Approach, implants and reduction

    The surgical approach, the implants used (plate type, screw sizes, wires, nails), and how anatomic the reduction was on the on-table image.

  3. 03 Findings

    Soft tissues, nerves, associated injuries

    The state of the skin and muscle, any nerve or tendon injury, syndesmotic instability, cartilage damage - anything that changes your prognosis.

  4. 04 Impression

    Weight-bearing, splint and follow-up

    Read this first: your weight-bearing status, the splint or brace, the antibiotic and DVT plan, and when you are seen in fracture clinic.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

ORIF is almost always covered by UK PMI when medically indicated - pre-authorisation depends on the fracture pattern and the implants.

Frequently asked

Everything we get asked about ORIF.

Straight answers on when to operate, which construct to use, cost, recovery and the risks worth taking seriously.

  • What is open reduction internal fixation (ORIF)?

    ORIF is the surgical realignment of a broken bone under direct vision, held in place with metalwork - plates, screws, wires or a rod. It is the workhorse of modern orthopaedic trauma when a fracture is displaced, unstable, involves a joint surface, or would heal badly if left in a cast.

  • When is ORIF the right choice - and when is it not?

    ORIF is indicated for displaced articular fractures, unstable patterns, failed closed reduction, polytrauma needing early mobilisation, pathological fractures and periprosthetic fractures. Stable, undisplaced fractures often do just as well in a cast. A minimally invasive plate (MIPO), an intramedullary nail, percutaneous screws or an external fixator may be better than a full open procedure - a good trauma surgeon lays out the options honestly.

  • Which fractures are commonly fixed with ORIF?

    Ankle (Weber A/B/C, bimalleolar, trimalleolar), distal radius (volar locking plate), scaphoid, elbow (distal humerus, olecranon, radial head), proximal humerus (PHILOS plate), clavicle, distal tibia (pilon), tibial plateau, calcaneus, Lisfranc, complex acetabular and pelvic fractures, young-patient femoral neck, periprosthetic fractures and complex hand and facial fractures.

  • What implants are used?

    Plates (dynamic compression, locking, buttress, T- or L-shaped, anatomical), screws (cortical, cancellous, cannulated, headless compression), wires (K-wires, cerclage, tension band constructs) and intramedullary devices (nails, rods, paediatric elastic nails). The choice is fracture-specific and planned on CT beforehand.

  • What are the AO principles the surgeon follows?

    Four: anatomic reduction of articular fractures, stable fixation appropriate to the pattern, preservation of the blood supply to bone and soft tissue (biological fixation), and early active mobilisation. Modern practice weighs anatomy against biology - pretty X-rays are not the point if they cost the soft-tissue envelope.

  • How long is recovery from ORIF, and when can I bear weight?

    Fracture-specific. Some constructs allow immediate weight-bearing; others need 6–12 weeks non-weight-bearing. Bony union is typically confirmed on X-ray at 6–12 weeks. Office work returns at 2–8 weeks depending on your job; sport at 6–12 months. Physiotherapy runs alongside the whole time.

  • What does ORIF cost privately in the UK?

    Roughly £8,000–£14,000 for a wrist, £9,000–£16,000 for an ankle, £12,000–£20,000 for a proximal humerus and £15,000–£30,000 for tibial plateau, pilon or complex periprosthetic work. NHS trauma is free at the point of use.

  • What are the main risks I should know about?

    Non-union (5–15%, higher in smokers, diabetics, open fractures and tibia), malunion, infection (2–5% closed; 10–30% Gustilo III open), hardware failure or symptomatic metal (10–30% ask for removal), nerve injury, DVT/PE, compartment syndrome (tibia/forearm), wound problems, refracture after hardware removal and post-traumatic osteoarthritis long term. A named trauma surgeon at the right centre is the single biggest thing you can do to reduce them.

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