The annual incidence of fractures in Britain is about 3.6% and the lifetime prevalence nearly 40%. Most of the 1.8 million fractures that occur in England each year are non‑complex, and include a wide range of injuries over the complete age range from infancy to old age. Many different bones can be involved and the mechanisms of injury are many and varied. The range of treatment options is also wide. Because of this, non‑complex fractures present an enormous challenge to the NHS.
Many non‑complex fractures get better with minimal clinical intervention. But healthcare can overcomplicate matters, with unnecessary time and effort being expended on fractures that are likely to get better without treatment. However, some non‑complex fractures can appear minor and be easily missed, but have the potential for a poor long-term outcome; scaphoid fracture is an example. So there is a need to achieve a balance between making sure that injuries needing treatment are not missed and treatment is avoided for injuries that are likely to get better on their own.
This guideline covers the diagnosis, management and follow up of non-complex fractures in children (under 16s) and adults (16 or over). It includes recommendations in the following key clinical areas:
initial pain management and immobilisation
acute stage assessment and diagnostic imaging
management in the emergency department
ongoing orthopaedic management
information and support for people with fractures and their families and carers
The guideline does not cover all potential situations for every individual fracture. It is based around a group of topics that should be considered as representative of an evidence-based guide to the general management of non-complex fractures and it provides recommendations for areas in which there is variation in practice. It does not cover skull fractures, hip fractures, spinal injuries, pelvic fractures, open fractures and the management of conditions such as osteoporosis and osteoarthritis. These are covered by other NICE guidelines.