Fractures are common: most people will experience at least one during a lifetime. With modern medical and surgical care most heal without problems or significant loss of function. However, fractures are associated with a range of complications. Acute complications are generally those occurring as a result of the initial trauma and include neurovascular and soft tissue damage, blood loss and localised contamination and infection. Delayed complications may occur after treatment or as a result of initial treatment and may include malunion, embolic complications, osteomyelitis and loss of function.

The risk of complications varies with the particular fracture, its site, circumstances and complexity, with the quality of management, with patient-specific risk factors such as age and comorbidities, and with post-fracture activities such as air travel and immobility.

Risk factors

Fracture complications are often variably defined, and there is a lack of consensus in their assessment, which makes their incidence difficult to estimate. Complications clearly vary with fracture site and nature and with quality of surgery but many also vary with patient attributes such as:

• Age.
• Nutritional staus.
• Smoking status.
• Alcohol use.
• Diabetes (type 1 or type 2).
• Use of non-steroidal anti-inflammatory drugs (NSAIDs) within 12 months.
• A recent motor vehicle accident (one month or less prior to fracture).
• Oestrogen-containing hormone therapy (although this may be a proxy for osteoporosis).