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. It aims to reduce deaths and long-term health problems by improving the quality of emergency and urgent care.
In November 2017, we amended recommendation 1.1.10 to change the wording from ‘administer prophylactic antibiotics’ to ‘consider administering prophylactic antibiotics’.
NHS England’s clinical reference group (CRG) produce 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.
This guideline includes recommendations on:
- managing pelvic fractures and open fractures in pre-hospital settings
- destination for people with suspected fractures
- assessing and managing vascular injury in hospital settings
- managing pelvic fractures and open fractures in hospital settings
- management of pilon and intra-articular distal tibia fractures in hospital settings
- documentation, and information and support for patients, family members and carers
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
Is this guideline up to date?
We checked this guideline in August 2018. A partial update will be planned. This update will focus on the role of negative pressure wound therapy in open fractures after wound excision or surgical debridement.
Guideline development process
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.