Fractures (Non-Complex): Assessment and Management

Excerpt

Two of the five guidelines in the NICE trauma suite relate to fractures. These are titled non-complex and complex fractures. In broad terms, non-complex fractures are those likely to be treated at the receiving hospital, whereas complex fractures require transfer or the consideration of transfer of the injured person to a specialist.

The annual incidence of fractures in Britain is estimated at 3.6% and the lifetime prevalence of fracture is near 40%.47 The majority of the 1.8 million fractures occurring every year in England are non-complex. These include a very wide range of injuries. The injured person may be any age from infancy to elderly. There are many anatomical sites at which a fracture may occur. The mechanisms of injury are many and varied. The range of treatment options is wide and varied. Because of these factors, non-complex fractures present an enormous challenge to healthcare systems.

Many non-complex fractures have a benign natural history and minimal clinical intervention is required. The nature of healthcare systems can be to overcomplicate matters; individuals offering treatment within their own field of expertise. Thus, surgeons may tend to operate and physiotherapists to provide therapy. A pathway expending unnecessary time and effort can evolve. Some non-complex fractures can present as an apparently minor and easily missed injury, yet still have a potential for a poor long-term outcome; scaphoid fracture is an example. Therefore, there is a need to explore a framework where important injuries are not missed whilst avoiding over-treating the majority of patients who have a benign injury.

It is clear that a single guideline cannot address individually all potential situations. However, since non-complex fractures present a huge burden and workload to the NHS it is a sound objective to provide a guideline to act as a rational basis for patient management embracing and accepting a wide range of circumstances. To this end, the guideline is based around a group of indicative topics chosen in the scoping stage of development.

Instead of tracing the pathway of a single injury, the guideline topics were chosen to inform various stages on a notional pathway of patient care. These topics were chosen on the basis of their prevalence, their relevance to a particular step in the patient pathway of care or perceived variation in current practice. It was inherent in the development of the guideline that, whilst recommendations are necessarily only made in relation to the individual topics of the scope, these recommendations should be considered as representative of the management of non-complex fractures in general.

Copyright © National Clinical Guideline Centre, 2016.