This guideline covers assessing and managing pelvic fractures, open fractures and severe ankle fractures (known as pilon fractures and intra-articular distal tibia fractures) in pre-hospital settings (including ambulance services), emergency departments and major trauma centres. It aims to reduce deaths and long-term health problems by improving the quality of emergency and urgent care. The guideline should be read alongside the NICE guidelines on major trauma, major trauma: service delivery, spinal injury and fractures (non-complex). In November 2017, we amended recommendation 1.1.10 to change the wording from ‘administer prophylactic antibiotics’ to ‘consider administering prophylactic antibiotics‘.