Complex fractures make up the minority of the 1.8 million fractures that occur in England each year, but are associated with considerable morbidity and are a large burden on healthcare resources. The treatment of complex fractures is often complicated and usually involves multiple healthcare professionals and specialists.

This guideline covers the triage, initial and acute stage assessment and management, imaging, referral to specialist care and treatment of complex fractures in children (under 16s) and adults (16 or over). It includes recommendations in the following key clinical areas:

  • management in pre‑hospital settings

  • immediate destination for people with suspected complex fractures

  • initial assessment and management in acute care

  • imaging and haemorrhage control of pelvic fractures

  • management of open fractures

  • management plan and referral for adults with pilon fractures and children with intra‑articular distal tibia fractures

  • documentation

  • information and support for people with complex fractures and their families and carers.

The guideline does not address all potential situations for every individual complex fracture. It is based around topics that should be considered as representative of an evidence‑based guide to the general management of complex fractures. It provides recommendations on open fractures, pelvic fractures, pilon fractures in adults and intra‑articular distal tibia fractures in children. It does not cover the prevention and follow‑up of complex fractures, and the management and follow‑up of dislocations and conditions such as osteoporosis and osteoarthritis.

The guideline does not cover non‑complex fractures, skull fractures, hip fractures and spinal injuries. These are covered by other NICE guidelines.