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Fractures (complex): assessment and management - NICE guideline

This guideline covers assessing and managing pelvic fractures, open fractures and severe ankle fractures (known as pilon fractures and intra-articular distal tibia fractures) in pre-hospital settings (including ambulance services), emergency departments and major trauma centres.

Fractures (complex): assessment and management aims to reduce deaths and long-term health problems by improving the quality of emergency and urgent care. NHS England’s clinical reference group (CRG) produces the service specification for major trauma. The CRG intends to consider the NICE guidelines on major trauma, major trauma: service delivery, spinal injury and complex fractures in future updates to the service specification which are planned for 2017.

The guideline should be read alongside the NICE guidelines on major traumamajor trauma: service deliveryspinal injury and fractures (non-complex).


This guideline includes recommendations on:

 Who is it for?

  • Healthcare professionals and practitioners who provide care for people with complex fractures in pre-hospital and hospital settings
  • People with complex fractures, their families and carers