Surgery for open reduction and internal fixation (ORIF) causes tissue swelling and pain in the surgical area. Swelling and pain can be reduced by performing distal elevation in the area of surgical ORIF. This study aimed to determine the effect of a 20° elevation on swelling and pain level of patients after surgery for ORIF of the lower extremities. A quasi-experi-mental design with one intervention group (pretest and posttest) and one control group was implemented. Thirty-four post-operative ORIF patients treated in one hospital in South Sumatera met the inclusion criteria and were divided into intervention and control groups. Swelling circumference was measured using tape meters, and pain level was assessed with a numeric rating scale. Dependent t-test, independent t-test, and Pearson correlation were applied for data analysis. Results showed that the average difference in swelling circumference and pain level between pre and post intervention was 1.93 ± 0.25 and 1.29 ± 0.35, respectively. Significant differences were found in the mean swelling circumference and pain level between the intervention and control groups (p = 0.000). Therefore a 20° elevation of lower extremity on the second day after ORIF for two days can be an alternative for nursing intervention to reduce swelling and pain. © JKI 2021.