1
00:00:00,240 --> 00:00:02,480
This is Laura Dirda with the Becker's Healthcare

2
00:00:02,480 --> 00:00:04,559
Podcast. I'm thrilled today to be joined by

3
00:00:04,559 --> 00:00:07,679
doctor Sameer Mehta, chief of orthopedic trauma and

4
00:00:07,679 --> 00:00:09,759
fracture service as well as associate professor in

5
00:00:09,759 --> 00:00:11,859
orthopedic surgery at University of Pennsylvania.

6
00:00:12,240 --> 00:00:13,439
Doctor Mehta, it's a pleasure to have you

7
00:00:13,439 --> 00:00:14,580
on the podcast today.

8
00:00:14,974 --> 00:00:16,595
Thanks for having me. Appreciate it.

9
00:00:17,054 --> 00:00:19,054
Absolutely. Now I'm excited for our conversation. I

10
00:00:19,054 --> 00:00:20,815
know a lot going on in orthopedics right

11
00:00:20,815 --> 00:00:22,255
now, and we'll dig into a variety of

12
00:00:22,255 --> 00:00:24,015
topics. But before we do, can you tell

13
00:00:24,015 --> 00:00:25,775
us a little bit more about yourself and

14
00:00:25,775 --> 00:00:26,835
University of Pennsylvania?

15
00:00:27,839 --> 00:00:31,199
Sure. I've been in practice now for almost

16
00:00:31,199 --> 00:00:33,539
nineteen almost, I guess, twenty years.

17
00:00:34,159 --> 00:00:36,560
I do, orthopedic trauma. I have,

18
00:00:37,039 --> 00:00:37,539
residents,

19
00:00:39,520 --> 00:00:42,020
busy academic level one university,

20
00:00:42,560 --> 00:00:43,060
center,

21
00:00:44,265 --> 00:00:47,244
in a very busy academic department at Penn.

22
00:00:48,185 --> 00:00:50,185
You know, we have obviously every service line

23
00:00:50,185 --> 00:00:51,885
covered, within the university

24
00:00:52,344 --> 00:00:52,844
ecosystem,

25
00:00:53,704 --> 00:00:56,825
and our accessory referral center, for a variety

26
00:00:56,825 --> 00:00:58,765
of conditions including orthopedic trauma.

27
00:01:00,420 --> 00:01:02,740
Got it. That's helpful to know. Well, you

28
00:01:02,740 --> 00:01:04,659
know, let's jump right in. Can you tell

29
00:01:04,659 --> 00:01:05,859
us a little bit more more about some

30
00:01:05,859 --> 00:01:07,540
of the trends you're watching currently? What's top

31
00:01:07,540 --> 00:01:09,480
of mind for you in the orthopedic space?

32
00:01:09,939 --> 00:01:11,619
Yeah. So I think in orthopedics, there are

33
00:01:11,619 --> 00:01:13,700
a couple of things. Obviously, my focus is

34
00:01:13,700 --> 00:01:15,000
on orthopedic trauma.

35
00:01:15,674 --> 00:01:17,354
And when we talk about trauma, we also

36
00:01:17,354 --> 00:01:18,814
talk about fracture care.

37
00:01:19,674 --> 00:01:20,655
And what's interesting

38
00:01:20,954 --> 00:01:23,114
is the transition. And I haven't made it

39
00:01:23,114 --> 00:01:24,575
yet, but I'm seeing it happen

40
00:01:24,954 --> 00:01:26,415
in some of my colleagues

41
00:01:26,795 --> 00:01:30,094
of fracture care transitioning to the ASD setting.

42
00:01:30,390 --> 00:01:31,130
So, you

43
00:01:31,510 --> 00:01:33,829
know, weekend warrior comes in with a broken

44
00:01:33,829 --> 00:01:34,329
ankle.

45
00:01:35,349 --> 00:01:38,090
They are splinted in the emergency room.

46
00:01:39,030 --> 00:01:40,870
In some scenarios, they might get admitted and

47
00:01:40,870 --> 00:01:42,390
operate on the next day. But if you

48
00:01:42,390 --> 00:01:44,635
have a busy level one trauma center, you're

49
00:01:44,635 --> 00:01:47,435
getting inundated with other more emergent or urgent

50
00:01:47,435 --> 00:01:47,935
injuries,

51
00:01:48,314 --> 00:01:50,075
and so it might be better served for

52
00:01:50,075 --> 00:01:52,155
that patient to go home and then get

53
00:01:52,155 --> 00:01:54,954
scheduled, quote, unquote, electively. I always sort of

54
00:01:54,954 --> 00:01:56,314
joke around when I talk about it. They

55
00:01:56,314 --> 00:01:57,890
joke around. I you know, it's always people

56
00:01:57,890 --> 00:01:59,569
that say I do elective trauma. And they're

57
00:01:59,569 --> 00:02:00,789
like, how do you have elective

58
00:02:01,329 --> 00:02:03,170
trauma? The other term we use is cold

59
00:02:03,170 --> 00:02:05,250
trauma. So you might get that ankle, which

60
00:02:05,250 --> 00:02:05,750
has

61
00:02:06,129 --> 00:02:07,569
a time component to it.

62
00:02:08,370 --> 00:02:10,385
You know, you might do that ankle in

63
00:02:10,385 --> 00:02:11,344
an ASC setting,

64
00:02:12,385 --> 00:02:14,145
rather than bring them back to the trauma

65
00:02:14,145 --> 00:02:16,224
center and take up a a spot in

66
00:02:16,224 --> 00:02:17,444
the trauma OR.

67
00:02:17,985 --> 00:02:20,004
And so while we haven't made that transition

68
00:02:20,784 --> 00:02:22,944
yet, even though we have an ASC as

69
00:02:22,944 --> 00:02:25,870
part of our, of our university hospital system,

70
00:02:26,569 --> 00:02:27,930
that may be something that we are going

71
00:02:27,930 --> 00:02:28,990
to start to employ,

72
00:02:29,449 --> 00:02:32,110
especially to decompress our dizzy

73
00:02:32,409 --> 00:02:34,430
trauma ORs within the hospital.

74
00:02:34,729 --> 00:02:36,490
And I think that trend is actually happening

75
00:02:36,490 --> 00:02:38,729
across the orthopedic crisis trend and move things

76
00:02:38,729 --> 00:02:41,125
into the ASD setting in general. We're seeing

77
00:02:41,125 --> 00:02:42,724
it with joints. We're seeing it with sports

78
00:02:42,724 --> 00:02:45,465
medicine, obviously. We're seeing it with shoulder, arthroplasty,

79
00:02:45,685 --> 00:02:46,985
and foot and ankle. And so,

80
00:02:47,604 --> 00:02:50,745
trauma, which has historically been a more hospital

81
00:02:50,884 --> 00:02:51,384
based

82
00:02:53,060 --> 00:02:54,039
service line,

83
00:02:54,580 --> 00:02:55,800
there are now opportunities

84
00:02:56,099 --> 00:02:58,259
to to take that to the ASC for

85
00:02:58,259 --> 00:02:59,479
these less

86
00:03:00,020 --> 00:03:00,520
emergent

87
00:03:00,900 --> 00:03:02,919
but still time sensitive injuries.

88
00:03:05,115 --> 00:03:07,455
That's helpful to understand. And, you know, definitely

89
00:03:07,834 --> 00:03:09,995
a a lot going on, in that space.

90
00:03:09,995 --> 00:03:11,134
And I'm curious,

91
00:03:11,435 --> 00:03:12,974
how do you see some of these,

92
00:03:14,235 --> 00:03:16,155
these issues? And and certainly,

93
00:03:16,474 --> 00:03:17,914
folks coming in and needing,

94
00:03:18,474 --> 00:03:21,719
you know, more care, from trauma really, you

95
00:03:21,719 --> 00:03:22,219
know,

96
00:03:22,680 --> 00:03:25,020
continuing to grow and evolve over time.

97
00:03:25,560 --> 00:03:26,840
Yeah. So I think there are a couple

98
00:03:26,840 --> 00:03:28,459
of things that I think are

99
00:03:28,759 --> 00:03:30,840
really growing a lot. I think we're seeing

100
00:03:30,840 --> 00:03:33,180
an an a tremendous increase

101
00:03:34,014 --> 00:03:34,675
in geriatric

102
00:03:35,055 --> 00:03:35,555
trauma.

103
00:03:36,175 --> 00:03:38,415
You know, people are getting older. They're living

104
00:03:38,415 --> 00:03:38,915
longer,

105
00:03:39,534 --> 00:03:41,395
and we're seeing an explosion

106
00:03:41,694 --> 00:03:43,715
on in terms of volume of

107
00:03:44,094 --> 00:03:46,594
older people, maybe more frail people

108
00:03:47,379 --> 00:03:49,960
breaking things, you know, beyond just the geriatric

109
00:03:50,099 --> 00:03:51,860
hip fracture. Right? We hear about that a

110
00:03:51,860 --> 00:03:54,020
lot. Our center, like many others, has a

111
00:03:54,020 --> 00:03:55,879
geriatric hip fracture program.

112
00:03:56,180 --> 00:03:58,840
But, really, what we're looking at is now

113
00:03:59,060 --> 00:04:02,094
sort of a geriatric fracture program in general,

114
00:04:02,094 --> 00:04:03,935
and our trauma team is seeing more and

115
00:04:03,935 --> 00:04:06,735
more patients coming in general surgery trauma that

116
00:04:06,735 --> 00:04:07,555
have geriatric

117
00:04:08,175 --> 00:04:11,294
fractures. And and, unfortunately, the geriatric patient or

118
00:04:11,294 --> 00:04:13,879
the frail patient has a different physiology

119
00:04:14,580 --> 00:04:17,699
than, say, that 20 year old who's involved

120
00:04:17,699 --> 00:04:19,620
in a high speed motor vehicle collision. Right?

121
00:04:19,620 --> 00:04:21,560
They have a different physiologic reserve.

122
00:04:22,019 --> 00:04:22,660
And so,

123
00:04:23,540 --> 00:04:26,419
the geriatric patient, the the frail patients, the

124
00:04:26,419 --> 00:04:29,314
elderly patients are coming in with polytrauma, the

125
00:04:29,314 --> 00:04:31,574
broken arm, a broken leg, a broken ankle.

126
00:04:32,035 --> 00:04:34,995
And, you know, that obviously, getting them up

127
00:04:34,995 --> 00:04:37,154
and getting them mobilized is really critical. You

128
00:04:37,154 --> 00:04:39,735
you know, making somebody who's in their eighties

129
00:04:39,794 --> 00:04:40,854
non weight bearing

130
00:04:41,160 --> 00:04:43,240
isn't really an option. I mean, think about

131
00:04:43,240 --> 00:04:45,180
how hard it is to navigate on crutches.

132
00:04:45,240 --> 00:04:47,480
You know, if you're young, imagine if you're

133
00:04:47,480 --> 00:04:49,480
80 with a bad shoulder because you've got

134
00:04:49,480 --> 00:04:51,960
a rotator cuff issue and now you're expected

135
00:04:51,960 --> 00:04:54,279
to, you know, gimp around on crutches. It

136
00:04:54,279 --> 00:04:55,340
it can be more dangerous

137
00:04:55,944 --> 00:04:58,105
sometimes than just fixing the fracture and letting

138
00:04:58,105 --> 00:05:00,425
patients walk immediately. And so, you know, we

139
00:05:00,425 --> 00:05:02,985
have we have definitely evolved to a a

140
00:05:02,985 --> 00:05:06,105
world where we are fixing more and more

141
00:05:06,105 --> 00:05:07,245
geriatric fractures

142
00:05:07,829 --> 00:05:10,389
And and even fractures that maybe historically we

143
00:05:10,389 --> 00:05:13,050
would have treated conservatively or nonoperatively,

144
00:05:13,829 --> 00:05:15,129
we're electing to

145
00:05:15,589 --> 00:05:18,490
fix patients so we can mobilize them faster.

146
00:05:18,629 --> 00:05:20,310
A classic one that I'm thinking about right

147
00:05:20,310 --> 00:05:22,955
now aside from the geriatric hip fracture is

148
00:05:22,955 --> 00:05:25,915
the geriatric pelvic fracture. Right? We are we

149
00:05:25,915 --> 00:05:28,395
are getting a little bit more aggressive, more

150
00:05:28,395 --> 00:05:31,194
pathway driven with those patients where, hey. If

151
00:05:31,194 --> 00:05:33,214
they can't mobilize on a

152
00:05:33,754 --> 00:05:36,250
what could be a nonoperative pelvis in a

153
00:05:36,250 --> 00:05:38,250
day or two or three, then we should

154
00:05:38,250 --> 00:05:40,110
fix them so they can then be aggressively

155
00:05:40,410 --> 00:05:42,670
mobilized without fear or risk of

156
00:05:43,050 --> 00:05:44,270
displacing their fracture.

157
00:05:44,889 --> 00:05:46,889
So we are seeing more of the and

158
00:05:46,889 --> 00:05:49,770
what's happening is these inpatient beds are being

159
00:05:49,770 --> 00:05:51,310
taken up by these patients,

160
00:05:52,125 --> 00:05:54,685
appropriately, and that transition for some of those

161
00:05:54,685 --> 00:05:57,724
less urgent emergent cases can happen to the

162
00:05:57,724 --> 00:05:59,985
ASC setting, and they can be discharged. So,

163
00:06:00,365 --> 00:06:02,685
the volume of beds doesn't increase. Right? We

164
00:06:02,685 --> 00:06:03,964
just have to figure out where to put

165
00:06:03,964 --> 00:06:05,024
all the chest pieces.

166
00:06:07,079 --> 00:06:09,079
That's helpful to understand. And, you know, really

167
00:06:09,079 --> 00:06:11,079
kind of thinking through that process in in

168
00:06:11,079 --> 00:06:11,579
workflows,

169
00:06:11,959 --> 00:06:12,939
to make that work,

170
00:06:13,800 --> 00:06:15,560
I I can imagine is easier said than

171
00:06:15,560 --> 00:06:16,379
done. But,

172
00:06:17,000 --> 00:06:19,324
just helpful to kind of get a a

173
00:06:19,324 --> 00:06:21,165
behind the scenes look at, you know, how

174
00:06:21,165 --> 00:06:21,904
things are,

175
00:06:22,925 --> 00:06:24,685
how things are, you know, kind of flowing

176
00:06:24,685 --> 00:06:26,605
and heading, what trends are top of mind

177
00:06:26,605 --> 00:06:29,004
in your space. Now I'm curious what else,

178
00:06:29,004 --> 00:06:30,605
you know, what are you focused on and

179
00:06:30,605 --> 00:06:32,125
most excited about right now? What are you

180
00:06:32,125 --> 00:06:34,410
really, looking into the future and saying that

181
00:06:34,410 --> 00:06:35,949
you're excited for?

182
00:06:36,810 --> 00:06:38,410
Yeah. I mean, I think there's a lot

183
00:06:38,410 --> 00:06:39,389
on the horizon,

184
00:06:40,169 --> 00:06:41,709
happening, in orthopedic

185
00:06:42,169 --> 00:06:44,649
trauma and the fracture space. I think, you

186
00:06:44,649 --> 00:06:45,149
know,

187
00:06:48,105 --> 00:06:48,925
there's obviously,

188
00:06:49,785 --> 00:06:52,125
you know, opportunities with things like biologics,

189
00:06:52,824 --> 00:06:54,105
you know, in terms of how to get

190
00:06:54,105 --> 00:06:55,564
fractures, you know, faster.

191
00:06:56,185 --> 00:06:58,125
I think one of the things that we

192
00:06:58,345 --> 00:07:00,204
are in 2026,

193
00:07:00,349 --> 00:07:03,069
we're realizing is that, you know, fracture care

194
00:07:03,069 --> 00:07:05,329
and trauma care is not a recreational

195
00:07:05,709 --> 00:07:07,329
sport. You know, historically,

196
00:07:08,349 --> 00:07:10,669
you know, everybody took call regardless of what

197
00:07:10,669 --> 00:07:11,970
your specialty was.

198
00:07:12,430 --> 00:07:14,689
You know, you graduated from orthopedic residency,

199
00:07:15,134 --> 00:07:17,055
You went into the community or you went

200
00:07:17,055 --> 00:07:19,375
to an academic level level one center, and

201
00:07:19,375 --> 00:07:22,415
the expectation was you were gonna fix fractures.

202
00:07:22,415 --> 00:07:24,175
You were gonna take care of whatever came

203
00:07:24,175 --> 00:07:28,014
in, regardless of of, your ability or your

204
00:07:28,014 --> 00:07:30,389
experience level because as the on call doctor,

205
00:07:30,389 --> 00:07:31,850
it was, quote, unquote, your responsibility.

206
00:07:32,550 --> 00:07:34,870
I think what has happened in in groups

207
00:07:34,870 --> 00:07:37,669
like the Orthopedic Trauma Association and the AO

208
00:07:37,669 --> 00:07:39,829
Foundation have done a really good job of

209
00:07:39,829 --> 00:07:40,329
educating

210
00:07:41,430 --> 00:07:44,544
folks on how to fix fractures and how

211
00:07:44,544 --> 00:07:46,544
to take care of patients who have traumatic

212
00:07:46,544 --> 00:07:47,685
orthopedic injuries.

213
00:07:48,224 --> 00:07:50,164
And then you've seen a growth of

214
00:07:50,544 --> 00:07:53,925
orthopedic trauma fellowship trained traumatologists,

215
00:07:55,339 --> 00:07:57,839
who have a a level of expertise in

216
00:07:58,060 --> 00:07:58,560
fixing,

217
00:07:59,420 --> 00:08:01,839
especially complex but even simple fractures.

218
00:08:02,379 --> 00:08:04,939
And so this concept of, well, everybody can

219
00:08:04,939 --> 00:08:06,620
do it or everyone should do it may

220
00:08:06,620 --> 00:08:07,500
be a little bit,

221
00:08:08,060 --> 00:08:08,560
historic.

222
00:08:09,345 --> 00:08:11,105
And it and like I said, trauma is

223
00:08:11,105 --> 00:08:13,105
not a recreational sport. And I think sometimes

224
00:08:13,105 --> 00:08:14,165
what happens with

225
00:08:16,145 --> 00:08:18,324
patients who come in who have really complex

226
00:08:18,785 --> 00:08:19,285
injuries

227
00:08:19,585 --> 00:08:21,125
or catastrophic injuries

228
00:08:21,439 --> 00:08:22,639
is that there's a little bit of a

229
00:08:22,639 --> 00:08:25,360
nihilistic approach to those patients. Like, well, you

230
00:08:25,360 --> 00:08:27,039
have a really bad injury, so you're having

231
00:08:27,039 --> 00:08:28,819
to have a really bad outcome. So sorry.

232
00:08:28,879 --> 00:08:30,399
Right? It's sort of the same thing when

233
00:08:30,399 --> 00:08:32,240
people have a cancer diagnosis. It's sort of

234
00:08:32,240 --> 00:08:33,919
like, well, at least you're not dead. And

235
00:08:33,919 --> 00:08:35,600
so it's sort of like, well but this

236
00:08:35,600 --> 00:08:37,554
is a this is a solvable cancer. Right?

237
00:08:37,554 --> 00:08:38,615
This is a solvable

238
00:08:38,915 --> 00:08:40,054
complex problem

239
00:08:40,514 --> 00:08:43,634
if solved by the person who has the

240
00:08:43,634 --> 00:08:45,955
skill set to solve it. And so not

241
00:08:45,955 --> 00:08:48,274
not every catastrophic injury has to have a

242
00:08:48,274 --> 00:08:49,575
catastrophic outcome.

243
00:08:50,139 --> 00:08:52,059
And I think that nihilistic view of, well,

244
00:08:52,059 --> 00:08:53,500
you had a really bad trauma, so you're

245
00:08:53,500 --> 00:08:54,860
gonna have a really bad outcome. I think

246
00:08:54,860 --> 00:08:56,059
we have to get past that a little

247
00:08:56,059 --> 00:08:58,699
bit. I do think that there is a

248
00:08:58,699 --> 00:09:00,940
layer or level of expertise that an orthopedic

249
00:09:00,940 --> 00:09:02,779
trauma surgeon can provide, and I'm excited to

250
00:09:02,779 --> 00:09:04,539
see that people, I think, are starting to

251
00:09:04,539 --> 00:09:05,759
to realize that.

252
00:09:06,434 --> 00:09:07,634
We, you know, we have more and more

253
00:09:07,634 --> 00:09:10,035
orthopedic surgeons who will reach out,

254
00:09:10,355 --> 00:09:12,674
about complex cases. They will send a text

255
00:09:12,674 --> 00:09:15,315
message or or something like that. I think

256
00:09:15,315 --> 00:09:17,795
what we're seeing now is also as our

257
00:09:17,795 --> 00:09:21,320
understanding of orthopedic trauma improves, we're seeing a

258
00:09:21,320 --> 00:09:24,200
growth in, you know, things like mixed mixed

259
00:09:24,200 --> 00:09:27,240
reality or augmented reality. You know, the the

260
00:09:27,240 --> 00:09:29,259
ability to pre op plan using,

261
00:09:29,879 --> 00:09:30,620
you know,

262
00:09:31,240 --> 00:09:32,003
devices that