Indication for ORIF is malrotated and/or malangulated fractures.
ORIF with one or more lag screws may be performed.
The fixation should be protected with a plate when only one lag screw is used or when further stability is desired. This permits a greater degree of stability which facilitates functional rehabilitation.
If possible, insert the lag screw through the plate to increase stability.
Toe fractures vs long bone fractures
Toe fractures are different from long bone fractures.
The bones are very small
Fracture gaps are small
Fixation devices don't need to counter large forces
Thus, following the AO principles is less critical than for long bones, and often isolated screws or K-wires alone will work satisfactorily.
Restoration of length, rotation, and angulation are important for cosmesis.
Timing of surgery
The timing of surgery is influenced by the soft tissue injury and the patient's physiologic status.
Dislocation or injuries associated with the skin at risk requires immediate intervention regardless of the amount of soft tissue swelling.
If possible, swelling should be significantly decreased before surgery, which can take up to two weeks in some instances.
Open fractures should be promptly irrigated and debrided, and treated with antibiotics. Definitive fracture fixation may not be possible during this setting.
Forefoot fractures do not contribute to physiologic instability. If there is no soft tissue at risk, urgent intervention is not required.