Priority 4 from the Complex Fractures PSP

UNCERTAINTY:Is it possible to determine which patients will develop complications, arthritis, and poor functional outcomes after complex fractures? (JLA PSP Priority 4)
Overall ranking	4
JLA question ID	0105/4
Explanatory note	Complex fractures may involve significant complications and there is relatively little recent high-quality evidence to help us prognosticate who will develop complications and how these could be prevented and managed
Evidence	Complications are discussed in both NG37 and NG39 as the outcomes of studies that have been reviewed. However, there is no evidence supplied on prediction of complications. Several studies use development of complications as a primary outcome measure when comparing treatments such as operative versus non-operative management of a fracture. However, no studies were found aiming to understand prognosis in these injuries. No other relevant trial evidence Cochrane/PUBMED since 2015. NICE Guideline 37 Fractures (complex): assessment and management NICE Guideline 39 Major trauma: assessment and initial management
Health Research Classification System category	Injuries and accidents

Extra information provided by this PSP
Original uncertainty examples	What are the benefits of an operation? ~ Cost effective treatments that can be reproduced in most surgeons hands ~ Incidence of secondary arthritis after joint fractures, what determines the development of secondary arthritis ~ Long term follow up studies (e.g. DRAFFT 5 years) ~ Does anatomical reduction mean better function ~ Will I get arthritis more badly in the areas affected? ~ surgery versus no surgery for complex fractures~ How can I make sure other joints aren’t badly affected?
Submitted by	20 x Surgeon/Doctor, 2 x Patient, 1 x Carer for patient, 1 x Physio, 1 x Unknown, 1 x Knows a patient

Extra information provided by this PSP

Original uncertainty examples

What are the benefits of an operation? ~ Cost effective treatments that can be reproduced in most surgeons hands ~ Incidence of secondary arthritis after joint fractures, what determines the development of secondary arthritis ~ Long term follow up studies (e.g. DRAFFT 5 years) ~ Does anatomical reduction mean better function ~ Will I get arthritis more badly in the areas affected? ~ surgery versus no surgery for complex fractures~ How can I make sure other joints aren’t badly affected?

Submitted by

20 x Surgeon/Doctor, 2 x Patient, 1 x Carer for patient, 1 x Physio, 1 x Unknown, 1 x Knows a patient

PSP information
PSP unique ID	0105
PSP name	Complex Fractures
Total number of uncertainties identified by this PSP.	58 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	8th June 2021