Complex Fracture Management

Complex fractures make up the minority of the all broken bones sustained in the United Kingdom each year but can be associated with considerable pain and complications following injury and are a large burden on healthcare resources. The treatment of these injuries is often complicated and usually involves multiple healthcare professionals and specialists.

These specialists include emergency doctors, surgeons, specialist nurses, people who take X-rays and scans (radiographers), people who advise on exercise and movement (physiotherapists) and people who help patients to regain their independence (occupational therapists).

As a Major Trauma Centre the types of complex fractures treated at James Cook Hospital include open fractures (when there is an open wound at the site of a broken bone) pelvic fractures, femoral fractures, tibial fractures, midfoot, hindfoot and severe ankle fractures (known as pilon fractures or intra-articular distal tibial fractures, when the fracture extends into the ankle joint)

Complex fractures exhibit certain characteristics which may include:

  • Soft tissue damage.
  • Severe cartilage injury to joint.
  • Bone loss due to severe trauma.
  • Presence of multiple fractures in a single bone.
  • Comminuted bone fragments (broken into many pieces).
  • Associated joint dislocation.

These types of injury require timely specialist care aimed at preserving life and limb whilst achieving an optimum functional outcome and continued quality of life for the injured patient.

Orthopaedic trauma surgeons

Consultant orthopaedic trauma surgeons at South Tees with a special interest in complex trauma and limb reconstruction are detailed below:

Consultant and positions of responsibility Specialist interest Weekly schedule Contact details
Mr Will Eardley
Orthopaedic trauma lead
Research chair, AOUK
Research chair, OTS
BOA Trauma group member
TARN national committee member and orthopaedic lead
Trauma and limb reconstruction surgery.
Internal and ring fixation for open fractures, pilon and plateau fractures
Chest wall reconstruction
Trust lead for deformity and infection surgery, especially for infection following surgical fixation
Monday – Trauma surgery
Tuesday – Trauma surgery / on call
Wednesday – Trauma limb reconstruction Surgery and research
Thursday – Complex injury/ limb reconstruction clinic
Friday – N/A
Tel: 01642 854302
Mr David Ferguson
British Orthopaedic Association clinical leadership fellow, sponsored by the British Limb Reconstruction Society
British Elbow and Shoulder Society Liaison with British Society of Children’s Orthopaedic Surgeons
Paediatric orthopaedics
Adult and paediatric limb reconstruction
Major trauma
Paediatric orthopaedics
Adult and paediatric limb reconstruction
Major trauma
Monday – James Cook PAED Clinic
(NTGH 2nd Monday of the month)
Tuesday – Trauma surgery / on call.
Wednesday – Trauma surgery / trauma Limb reconstruction surgery
Thursday – Limb reconstruction clinic
Friday – Paediatric surgery (alternate weeks)
Tel: 01642 835513
Mr James McVie
British Elbow & Shoulder Society (BESS) member
British Limb Reconstruction Society (BLRS) member
British Orthopaedic Association (BOA) member
British Trauma Society (BTS)
British Medical Association (BMA) member
Shoulder & elbow surgery (elective & complex trauma)
Major trauma
Limb reconstruction (limb deformity, fracture non-union / mal-union, bone infection)
Monday – James Cook clinic
Tuesday – Trauma surgery
Wednesday – Elective surgery Friarage/ James Cook clinic
Thursday – Trauma surgery / on call
Friday – N/A
Tel: 01642 854380
Mr Mohammed Al-Maiyah Foot and ankle surgery.
Complex trauma and limb reconstruction surgery.
Monday – Trauma surgery / On call
Tuesday – Friarage clinic
Wednesday – N/A
Thursday – James Cook clinic
Friday – Elective surgery Friarage
Tel: 01642 854513
Mr Craig White Pelvic surgery
Hip surgery
Young adult hip problems
Trauma
Monday – Elective surgery James Cook
Tuesday – James Cook clinic
Wednesday – N/A
Thursday – Trauma surgery / On call
Friday – N/A
Tel: 01642 850850 Ext 54119
Mr Philip Holland Shoulder replacement surgery
Arthroscopic shoulder surgery
Elbow surgery
Trauma surgery
Monday – Trauma surgery / on call
Tuesday – N/A
Wednesday – Friarage clinic
Thursday – N/A
Friday – Elective surgery Friarage
Tel: 01609 763336
Mr Paul Baker
Director for research and innovation for the South Tees Hospitals NHS Foundation Trust.
National Institute for Health Research grant holder for the OPAL study (Occupational advice for patients undergoing arthroplasty of the lower limb)
Local Clinical Research Network lead for orthopaedics
NICE clinical guideline committee member
British Associations for Surgery of the Knees revision knee working group member
Hip and knee arthroplasty
Revision hip & knee surgery
Orthopaedic trauma
Major trauma care
Monday – James Cook clinic. Prosthetic joint infection MDT Alt weeks
Tuesday – Elective surgery (Alt weeks James Cook/Friarage)
Wednesday – Trauma surgery / On call
Thursday – Research
Friday – N/A
Tel: 01642 854479
Mr Ian Wallace Adult lower limb primary arthroplasty
Revision hip and knee arthroplasty
Arthroscopic knee surgery
Orthopaedic trauma surgery
Monday – N/A
Tuesday – James Cook clinic AM / Friarage clinic PM
Wednesday – Trauma surgery / on call
Thursday – Elective surgery Friarage
Friday – James Cook clinic
Tel: 01642 854119
Mr Simon Jameson
Local lead for prosthetic joint infection and orthopaedic oncology groups
Orthopaedic Device Evaluation Panel (ODEP) committee member
British Hip Society National Joint Registry representative.
Visiting Senior Research Fellow, Dept of Health Sciences, University of York
Hip and knee replacement
Revision hip surgery
Peri-prosthetic joint infection
Orthopaedic trauma
Monday – James Cook clinic. Prosthetic joint infection MDT alt weeks
Tuesday – N/A
Wednesday – Trauma surgery / On call
Thursday – Elective surgery (James Cook / Friarage alt weeks)
Friday – Friarage clinic
Tel: 01609 764521
Mr Andrew Gray
Clinical director trauma and orthopaedic department within South Tees Hospitals NHS Foundation Trust.
Fragility fracture lead and founder member for the UK Orthopaedic Trauma.
National Osteoporosis Society representative
Lower limb editor for the trauma journal ‘Injury’.
Faculty AO trauma courses.
Pelvic and acetabular fracture surgery.
Lower limb trauma with an elective practice that includes hip and knee replacements
Soft tissue knee open / arthroscopic surgery.
Monday – Friarage clinic
Tuesday – N/A
Wednesday – Trauma surgery / elective surgery Friarage alt weeks
Thursday – Trauma surgery / on call
Friday – N/A
Tel: 01642 854314
Mr Ian McMurtry Lower limb arthroplasty
Orthopaedic trauma surgery
Monday – Trauma surgery / on call
Tuesday – N/A
Wednesday – Elective surgery Friarage
Thursday – Friarage clinic
Friday – James Cook clinic
Tel: 01642 854479
Mr Tim Bonner Complex fracture & soft tissue knee injuries
Knee replacement surgery
Orthopaedic trauma surgery
Monday – Elective surgery Friarage
Tuesday – Military RRU clinic
Wednesday – James Cook Acute knee clinic / Knee MDT
Thursday – Trauma surgery / on call
Friday – James Cook clinic
Tel:01642 850850 Ext 54479

To promote the best outcome for patients who sustain such severe injuries trauma networks and hospitals require the appropriate pathways and infrastructure in place to minimise complications and enable optimum recovery.

To promote the provision of quality, evidence based care in the UK national guidelines, BOA Standards for Trauma and Orthopaedics (BOASTs), have been developed as a standard against which to measure best practice.

The care that we provide for patients at James Cook is measured against these standards as we strive to achieve excellence in clinical care provision.

Orthoplastic centre

We are privileged at James Cook Hospital to be in a position to offer the expertise of several orthopaedic and plastic surgeons who are able to provide specialist care for individuals who have sustained complex limb injuries.

We are able to provide a combined service for orthopaedic and plastic surgery in which consultants from both specialties work simultaneously to treat open fractures as part of regular, combined orthopaedic and plastic surgery operating lists.

Patients are also able to be provided with follow up in a dedicated limb reconstruction clinic where monitoring of their progress and rehabilitation can continue to be monitored by the specialist team.

Specialist paediatric orthopaedic trauma surgeons are also available to provide expert care for children who have sustained these types of complex injuries.

Additional patient and public information relating to complex fracture management can be found online at the National Institute for Health and Care Excellence