Synopsis
Reconstruct why a fall occurred, identify modifiable recurrence risks and link fracture treatment to tailored falls, bone-health and functional interventions before another injury occurs.
- A fragility fracture is a sentinel event: treat the injury, but also investigate the fall, future fracture risk, bone health and the person's ability to recover safely.
- Under NICE NG249, a fall causing injury that needed medical or surgical treatment qualifies for comprehensive falls assessment and management.
- First-line history reconstructs activity, direction, warning symptoms, loss of consciousness, time on the floor, footwear, alcohol, medicines, previous falls and witness account.
- Comprehensive assessment includes cardiovascular examination with lying and standing blood pressure, cognition and mood, gait, balance, strength, vision, hearing, feet, continence, nutrition, neurological examination and osteoporosis risk.
- Do not use a numerical falls-risk prediction score to decide who receives inpatient assessment; address the person's observed and identified factors.
- Perform structured medication review, especially psychotropics, sedatives and blood-pressure-lowering medicines, but taper or adjust safely rather than abruptly stopping necessary treatment.
- Offer a progressive, tailored falls-prevention exercise programme and home-hazard assessment when indicated; occupational-therapy delivery of home assessment should be considered.
- Initiate or hand over secondary fracture prevention through a named fracture liaison or bone-health pathway rather than treating the fracture as an isolated accident.
Key red flags
Loss of consciousness during exertion, while supine or with chest pain, palpitations or a family history of sudden death requires urgent cardiovascular evaluation.
Persistent focal weakness, speech disturbance, severe new headache or inability to coordinate after the event needs an acute neurological and head-injury pathway.
Fever, hypotension, hypoxia, acute confusion or markedly reduced intake suggests illness precipitated the fall and needs treatment alongside fracture care.
A prolonged lie, inability to rise, pressure injury, hypothermia, dehydration or dark urine raises concern for rhabdomyolysis, kidney injury and safeguarding needs.
Repeated falls with bruises of different ages, fearfulness, neglect or an inconsistent mechanism should prompt sensitive safeguarding assessment.
New back pain, weakness, saddle sensory change or bladder or bowel dysfunction after a fragility event requires emergency spinal assessment.
Investigation priorities
Identify the person's cardiovascular, neurological, sensory, functional, medication, environmental and psychological risk factors.
Management branches
A fall causes a suspected fragility fracture or physiological deterioration.
- Use ABCDE and trauma assessment, provide analgesia and protect the injured region.
- Check bedside glucose, observations and neurological status and examine for head injury and complications of a long lie.
- Reconstruct warning symptoms, awareness and witness account before calling the event mechanical.
- Activate cardiac, neurological, infectious or other urgent pathways when red flags are present.