Should Surgery Be Considered for Elderly Asthmatic Patients with Fractures?

Should elderly patients with asthma undergo surgical fixation for fractures?

Dear Dr.
Chen,
My father is currently 74 years old and has a history of asthma for about ten years.
Apart from using bronchodilators, he also takes oral corticosteroids during more severe episodes.
The night before last, my father accidentally slipped and suffered a comminuted fracture about ten centimeters above his right ankle, with some puncture wounds.
After being rushed to the hospital, the doctor initially planned to perform surgery to stabilize the fracture with screws.
However, considering my father's asthma, the surgery was not performed.
Instead, the bones were roughly realigned, the wound was cleaned, and sutured.
The doctor indicated that since surgery was not performed within eight hours of the fracture, it cannot be done now.
My father is currently in a cast and will be monitored for a week.
If the bone healing appears satisfactory, surgery will not be necessary.
I have the following questions:
1.
Is it true that surgery cannot be performed on patients with asthma who have fractures?
2.
Will using only a cast for stabilization affect my father's future recovery? Is there a possibility that he will not be able to walk normally again?
3.
Now that it has been three days, is it still possible to stabilize the fracture surgically? Or, as the doctor mentioned, is it only feasible to use a cast since more than eight hours have passed?
Thank you!

hjliao, 30~39 year old female. Ask Date: 2004/02/05

Dr. Chen Xingyuan reply Orthopedics

Dear User,
Your father has a history of asthma, which significantly increases the anesthetic risks associated with surgery.
Typically, prior to surgery, an anesthesiologist or pulmonologist will be consulted to assess the surgical risks and determine whether it is safe to proceed with anesthesia, or if it would be better to wait until his condition stabilizes.
Patient safety is the most important consideration.
Therefore, opting for a safer and more conservative treatment method when not absolutely necessary is appropriate.
As long as the fracture can be satisfactorily realigned, closed reduction followed by casting is a viable treatment option.
While casting provides less stability compared to fixation with plates or screws, it is still a reasonable choice, especially if the fracture can be maintained in position.
However, casting may require at least 2 to 3 months, which can be inconvenient in daily life.
Yet, this inconvenience is tolerable compared to the risks associated with surgery.
If the alignment of the fracture is not ideal, surgical intervention for reduction and fixation can be considered.
However, the risks of anesthesia still remain.
If surgery is deemed necessary, it is best to wait until your father's condition is stable before proceeding with anesthesia and the surgical procedure.
As long as there are no infections at the wound or in the bone, and the fracture does not displace again, with appropriate rehabilitation and adherence to medical advice, your father's recovery should be promising.
Wishing your father a speedy and smooth recovery!
Sincerely,
Dr.
Chen

Reply Date: 2004/02/05

More Info

When considering surgery for elderly patients with asthma who have sustained fractures, several factors must be taken into account. Your father's case, involving a comminuted fracture of the lower leg, raises important questions about the timing and appropriateness of surgical intervention, particularly given his history of asthma and the recent nature of his injury.

1. Can Asthmatic Patients Undergo Surgery?
Asthma itself does not categorically preclude surgery; however, it does introduce additional risks that must be carefully evaluated. In patients with a history of asthma, particularly those who require frequent use of bronchodilators or systemic corticosteroids, the anesthetic management and postoperative care must be tailored to minimize respiratory complications. The decision to proceed with surgery often depends on the severity of the asthma, the patient's overall health status, and the urgency of the surgical intervention. In your father's case, the surgical team likely weighed the risks of anesthesia and potential respiratory complications against the benefits of immediate surgical fixation of the fracture.

2. Impact of Casting on Recovery:
Using a cast for immobilization can be an effective treatment for certain types of fractures, especially if surgical intervention is not feasible. However, the effectiveness of conservative management (casting) depends on the specific nature of the fracture and the alignment of the bone fragments. In cases of comminuted fractures, there is a risk that the fragments may not heal properly, potentially leading to malunion or nonunion. While many patients can regain function after conservative treatment, the long-term outcome can vary. It is essential to monitor the healing process through follow-up imaging and clinical assessments. If the fracture heals well, your father may regain the ability to walk normally, but this will depend on the quality of the healing and any complications that may arise.

3. Timing of Surgical Intervention:
The timing of surgery is critical in the management of fractures. Ideally, surgical fixation should occur within a few hours of the injury to optimize outcomes. However, if surgery is delayed beyond this window, as in your father's case, the risk of complications increases, and the likelihood of successful surgical intervention may decrease. After eight hours, the soft tissues around the fracture may begin to swell and become more difficult to manage surgically. Therefore, if the medical team has determined that surgery is no longer an option, it is likely due to concerns about the risks associated with the delayed intervention.

In summary, while asthma can complicate surgical decisions, it does not automatically rule out the possibility of surgery. The choice to proceed with conservative management using a cast should be closely monitored, and follow-up evaluations will be necessary to assess healing and functional recovery. If there are concerns about the healing process or if your father's condition changes, it is crucial to maintain open communication with the healthcare team to explore all available options for his care.

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