MedBalans

Major Bone Fractures

Adults · emergency only · brief protocol

Algorithm

  1. ATLS primary survey; control hemorrhage (tourniquet if life-threatening limb bleed).
  2. Neurovascular assessment distal to fracture; document before and after splinting.
  3. Splint in position found unless pulseless — then gentle alignment.
  4. Analgesia: IV morphine or fascia iliaca block for hip.
  5. X-ray after stabilization; orthopedics for displacement/instability.

Red flags

  • • Pelvic / femoral bleeding — hemorrhage control and trauma team
  • • Neurovascular compromise distal to fracture
  • • Open fracture — antibiotics and tetanus per protocol

Medications by step

Step 1 — Analgesia

  • Morphine · i.v.

    0.1 mg/kg IV (max 10 mg)

  • Paracetamol · i.v./p.o.

    1 g IV/PO

Step 2 — Anticoagulation (if indicated)

  • Enoxaparin · s.c.

    40 mg SC daily if immobilized

References

  • • BOAST — Fracture management (2022)

Updated: Июль 2026