Bone Fracture Treatment in Pokhara: Emergency Orthopedic Care at A&B Hospital
A fracture is a break in the continuity of bone. In Nepal, fractures occur across all age groups and settings — children falling from trees, workers injured at construction sites, trekkers twisting their ankles on mountain trails, elderly patients falling at home, and road traffic accident victims presenting in critical condition. Each fracture is different, and the treatment must match the fracture type, location, stability, and the patient’s overall condition.
A&B International Hospital operates a 24-hour emergency orthopedic service in Pokhara. Fractures are assessed, imaged, and treated on arrival. The full range of fracture management — from a simple plaster cast to emergency surgical fixation for compound fractures — is available without requiring transfer to Kathmandu.
What Are the Different Types of Bone Fractures?
Fractures are classified by their pattern, stability, skin integrity, and mechanism of injury. The classification determines treatment approach and recovery expectations.
By skin integrity:
- Closed (simple) fracture: The bone is broken but skin remains intact. The most common type. Treated conservatively or surgically depending on displacement and stability.
- Open (compound) fracture: The bone breaks through the skin, or a wound communicates with the fracture site. This is an orthopedic emergency — the exposed bone is at immediate risk of infection, which can progress to osteomyelitis (bone infection) if not treated urgently.
By fracture pattern:
- Transverse fracture: Clean break perpendicular to the bone axis
- Oblique fracture: Angled break — tends to shift and may require surgical fixation
- Spiral fracture: Caused by a twisting force; raises concern for abuse in children
- Comminuted fracture: Bone shatters into multiple fragments; usually requires surgery
- Greenstick fracture: Incomplete fracture where the bone bends but does not fully break; occurs in children’s softer bones
- Stress fracture: Hairline crack from repetitive loading, not a single impact — common in runners, trekkers, and military recruits
By displacement:
- Undisplaced: Fragments remain aligned — often managed in a cast
- Displaced: Fragments have shifted out of normal alignment — usually requires reduction (realignment), which may be done with or without surgery
What First Aid Should You Give for a Fracture Before Reaching the Hospital?
For any suspected fracture, the goals of first aid are to immobilize the injured area, reduce pain, prevent further injury, and transport the patient safely. Do not attempt to straighten a fractured limb.
First aid for fractures:
- Immobilize the limb using a splint (a rolled magazine, stick, or board padded with cloth) — do not force alignment
- Do not remove clothing from an open fracture; instead, cover the wound with a clean cloth to reduce contamination
- Elevate the limb if possible to reduce swelling
- Apply ice (wrapped in cloth) if available — not directly to skin
- Do not give food or water — the patient may need general anesthesia at the hospital
- Call for help or transport immediately — open fractures, femur fractures, pelvic fractures, and any fracture with neurological symptoms are emergencies
For spinal injury: suspect a spinal fracture in any patient with neck or back pain after a fall from height, vehicle accident, or diving injury. Do not move the patient without support for the head and spine. Log-roll technique should be used for transport if available.
How Are Fractures Diagnosed at A&B Hospital Pokhara?
Fracture diagnosis at A&B begins with a clinical assessment — history of the injury mechanism, examination of deformity, swelling, tenderness, and neurovascular status (pulse and sensation in the limb distal to the fracture).
On-site imaging at A&B:
- X-ray: The primary diagnostic tool. Two views of the injured area (at minimum) are taken, including the joints above and below the fracture. X-ray confirms fracture presence, pattern, and alignment.
- CT scan: For complex fractures (pelvis, spine, calcaneus, tibial plateau) where X-ray does not fully characterize the fracture anatomy. CT guides surgical planning.
- MRI: Used when stress fractures are suspected but X-ray is normal, or for soft tissue injury assessment alongside a fracture.
What Is the Difference Between Casting and Surgical Fixation for Fractures?
The choice between casting (non-surgical) and surgical fixation depends on fracture stability, displacement, location, patient age, and activity demands. Not every fracture needs surgery, but certain fractures consistently do poorly without it.
Casting (non-surgical):
- Appropriate for undisplaced or minimally displaced stable fractures
- Used for most pediatric forearm fractures, undisplaced ankle fractures, undisplaced clavicle fractures
- Duration: 3–6 weeks for upper limb; 6–12 weeks for lower limb, depending on bone and fracture type
- Follow-up X-rays at 1–2 week intervals confirm maintained alignment
Surgical fixation — types used at A&B:
- Plates and screws: Used for displaced fractures of the forearm, wrist, ankle, tibia, femur, and clavicle. The plate spans the fracture, and screws compress the fragments together.
- Intramedullary nailing: A metal nail is inserted into the medullary canal (hollow center) of long bones — most commonly the tibia and femur. This technique allows early weight-bearing and is mechanically strong.
- External fixation: Metal pins inserted into bone connected by an external frame — used as a temporizing measure for open fractures, polytrauma patients, or severe soft tissue injury requiring wound management before definitive fixation.
- Tension band wiring / Kirschner wires: Used for smaller fractures (olecranon, patella, small hand bones)
How Are Open (Compound) Fractures Managed as an Emergency?
Open fractures are treated as orthopedic emergencies at A&B. The combination of bone exposure and contamination creates a narrow time window — surgical debridement and fracture stabilization should occur within 6–8 hours of injury to minimize infection risk.
Emergency protocol for open fractures at A&B:
- Wound assessment and sterile coverage on arrival
- IV antibiotics initiated immediately — typically a cephalosporin, with metronidazole added for heavily contaminated wounds
- Tetanus prophylaxis administered
- X-ray imaging to characterize the fracture
- Urgent surgical debridement — thorough washout and removal of devitalized tissue
- Fracture stabilization — external fixation or internal fixation depending on wound condition and soft tissue status
- Wound management — primary closure if clean, or staged closure/skin grafting for contaminated wounds
- IV antibiotics continued for 24–72 hours post-surgery
How Do Fracture Healing Timelines Differ by Bone Type?
Fracture healing time varies significantly by location, patient age, bone quality, blood supply, and fracture stability. These are approximate averages for uncomplicated fractures in healthy adults:
| Bone | Approximate Healing Time |
|---|---|
| Finger / toe | 3–5 weeks |
| Wrist (distal radius) | 6–8 weeks |
| Forearm (radius/ulna) | 8–12 weeks |
| Clavicle | 6–8 weeks |
| Ankle | 6–10 weeks |
| Tibia (with nail) | 10–16 weeks |
| Femur (with nail) | 12–20 weeks |
| Vertebra (compression) | 8–12 weeks |
Children heal faster than adults — a femur fracture that takes 16 weeks in an adult may heal in 6–8 weeks in a child. Elderly patients with osteoporosis heal more slowly and may experience non-union (failure to heal) requiring additional intervention.
How Do Fractures in Children Differ from Adults?
Children’s bones are more flexible, contain a growth plate (physis) at each end, and heal faster than adult bone. These differences create both advantages (faster healing) and unique risks (growth plate injury).
Growth plate fractures (Salter-Harris fractures): The growth plate is the weakest part of a child’s bone — often weaker than the surrounding ligaments. An injury that would cause a ligament sprain in an adult causes a growth plate fracture in a child. Salter-Harris classification (I–V) determines the risk of growth disturbance and guides treatment.
Growth plate injuries that are not properly recognized and treated can lead to angular deformity or limb length discrepancy as the child grows. Prompt orthopedic assessment of any injured limb in a child is important.
What Nutrition Supports Fracture Healing?
Bone healing requires specific nutritional inputs. Patients recovering from fractures at A&B are advised on nutritional support:
- Calcium: 1000–1200 mg/day (dairy, dark leafy vegetables, fortified foods)
- Vitamin D: Essential for calcium absorption — many Nepali patients are deficient. Supplementation with 1000–2000 IU/day is often recommended.
- Protein: Adequate protein intake supports bone matrix formation — lean meat, lentils, eggs, dairy
- Vitamin C: Needed for collagen synthesis — citrus fruits, amla
- Zinc: Supports wound and bone healing — nuts, seeds, legumes
- Avoid: Smoking (significantly impairs fracture healing) and excessive alcohol
Emergency Fracture Care Available 24/7 at A&B International Hospital
A&B International Hospital handles fracture emergencies around the clock. From first assessment and imaging to casting or surgical fixation, the entire care pathway is available in Pokhara — no Kathmandu transfer required for the majority of fractures.
A&B International Hospital
Pokhara-02, Bindhyaabasini
Phone: +977 061-412512
Website: abinthospital.com
ECHS cashless coverage available for eligible patients. Walk in or call for emergency fracture care.
