Open reduction of fracture with internal fixation is manipulative correction of a fracture to anatomical position after incision into the fracture site. Open reduction of a fracture involves deliberate exposure of the bone by the surgeon for the purpose of restoration of the proper anatomy.
Internal fixation is the stabilization of a fracture that is either undisplaced or has already undergone closed or open reduction. Closed reduction of fracture with internal fixation involves reducing the fracture without incision to the fracture site followed by incision for placement of the internal fixation device. Internal fixation devices include pins, wires, screws, plates, and intramedullary nails. Placement of internal fixation devices immobilize the fracture site; it is not a form of fracture reduction.
Internal fixation does not always require direct exposure of the fracture site, however, in most cases it does.
Pins can be introduced through the skin and drilled into the bone to provide fracture stabilization. This type of fixation is called percutaneous skeletal fixation and does not require direct exposure of the fracture site. Insertion of Steinmann pins or any other type of pins through the skin is considered percutaneous treatment. Kirschner wires and Steinmann pins are essentially the same device which differ only in size.
Percutaneous pinning is usually performed on a fracture that is not displaced or has undergone a closed reduction. Frequently, percutaneous pinning is used in combination with other types of internal fixation devices.