This is Laura Dirda with the Becker's Healthcare
Podcast. I'm thrilled today to be joined by
doctor Sameer Mehta, chief of orthopedic trauma and
fracture service as well as associate professor in
orthopedic surgery at University of Pennsylvania.
Doctor Mehta, it's a pleasure to have you
on the podcast today.
Thanks for having me. Appreciate it.
Absolutely. Now I'm excited for our conversation. I
know a lot going on in orthopedics right
now, and we'll dig into a variety of
topics. But before we do, can you tell
us a little bit more about yourself and
University of Pennsylvania?
Sure. I've been in practice now for almost
nineteen almost, I guess, twenty years.
I do, orthopedic trauma. I have,
residents,
busy academic level one university,
center,
in a very busy academic department at Penn.
You know, we have obviously every service line
covered, within the university
ecosystem,
and our accessory referral center, for a variety
of conditions including orthopedic trauma.
Got it. That's helpful to know. Well, you
know, let's jump right in. Can you tell
us a little bit more more about some
of the trends you're watching currently? What's top
of mind for you in the orthopedic space?
Yeah. So I think in orthopedics, there are
a couple of things. Obviously, my focus is
on orthopedic trauma.
And when we talk about trauma, we also
talk about fracture care.
And what's interesting
is the transition. And I haven't made it
yet, but I'm seeing it happen
in some of my colleagues
of fracture care transitioning to the ASD setting.
So, you
know, weekend warrior comes in with a broken
ankle.
They are splinted in the emergency room.
In some scenarios, they might get admitted and
operate on the next day. But if you
have a busy level one trauma center, you're
getting inundated with other more emergent or urgent
injuries,
and so it might be better served for
that patient to go home and then get
scheduled, quote, unquote, electively. I always sort of
joke around when I talk about it. They
joke around. I you know, it's always people
that say I do elective trauma. And they're
like, how do you have elective
trauma? The other term we use is cold
trauma. So you might get that ankle, which
has
a time component to it.
You know, you might do that ankle in
an ASC setting,
rather than bring them back to the trauma
center and take up a a spot in
the trauma OR.
And so while we haven't made that transition
yet, even though we have an ASC as
part of our, of our university hospital system,
that may be something that we are going
to start to employ,
especially to decompress our dizzy
trauma ORs within the hospital.
And I think that trend is actually happening
across the orthopedic crisis trend and move things
into the ASD setting in general. We're seeing
it with joints. We're seeing it with sports
medicine, obviously. We're seeing it with shoulder, arthroplasty,
and foot and ankle. And so,
trauma, which has historically been a more hospital
based
service line,
there are now opportunities
to to take that to the ASC for
these less
emergent
but still time sensitive injuries.
That's helpful to understand. And, you know, definitely
a a lot going on, in that space.
And I'm curious,
how do you see some of these,
these issues? And and certainly,
folks coming in and needing,
you know, more care, from trauma really, you
know,
continuing to grow and evolve over time.
Yeah. So I think there are a couple
of things that I think are
really growing a lot. I think we're seeing
an an a tremendous increase
in geriatric
trauma.
You know, people are getting older. They're living
longer,
and we're seeing an explosion
on in terms of volume of
older people, maybe more frail people
breaking things, you know, beyond just the geriatric
hip fracture. Right? We hear about that a
lot. Our center, like many others, has a
geriatric hip fracture program.
But, really, what we're looking at is now
sort of a geriatric fracture program in general,
and our trauma team is seeing more and
more patients coming in general surgery trauma that
have geriatric
fractures. And and, unfortunately, the geriatric patient or
the frail patient has a different physiology
than, say, that 20 year old who's involved
in a high speed motor vehicle collision. Right?
They have a different physiologic reserve.
And so,
the geriatric patient, the the frail patients, the
elderly patients are coming in with polytrauma, the
broken arm, a broken leg, a broken ankle.
And, you know, that obviously, getting them up
and getting them mobilized is really critical. You
you know, making somebody who's in their eighties
non weight bearing
isn't really an option. I mean, think about
how hard it is to navigate on crutches.
You know, if you're young, imagine if you're
80 with a bad shoulder because you've got
a rotator cuff issue and now you're expected
to, you know, gimp around on crutches. It
it can be more dangerous
sometimes than just fixing the fracture and letting
patients walk immediately. And so, you know, we
have we have definitely evolved to a a
world where we are fixing more and more
geriatric fractures
And and even fractures that maybe historically we
would have treated conservatively or nonoperatively,
we're electing to
fix patients so we can mobilize them faster.
A classic one that I'm thinking about right
now aside from the geriatric hip fracture is
the geriatric pelvic fracture. Right? We are we
are getting a little bit more aggressive, more
pathway driven with those patients where, hey. If
they can't mobilize on a
what could be a nonoperative pelvis in a
day or two or three, then we should
fix them so they can then be aggressively
mobilized without fear or risk of
displacing their fracture.
So we are seeing more of the and
what's happening is these inpatient beds are being
taken up by these patients,
appropriately, and that transition for some of those
less urgent emergent cases can happen to the
ASC setting, and they can be discharged. So,
the volume of beds doesn't increase. Right? We
just have to figure out where to put
all the chest pieces.
That's helpful to understand. And, you know, really
kind of thinking through that process in in
workflows,
to make that work,
I I can imagine is easier said than
done. But,
just helpful to kind of get a a
behind the scenes look at, you know, how
things are,
how things are, you know, kind of flowing
and heading, what trends are top of mind
in your space. Now I'm curious what else,
you know, what are you focused on and
most excited about right now? What are you
really, looking into the future and saying that
you're excited for?
Yeah. I mean, I think there's a lot
on the horizon,
happening, in orthopedic
trauma and the fracture space. I think, you
know,
there's obviously,
you know, opportunities with things like biologics,
you know, in terms of how to get
fractures, you know, faster.
I think one of the things that we
are in 2026,
we're realizing is that, you know, fracture care
and trauma care is not a recreational
sport. You know, historically,
you know, everybody took call regardless of what
your specialty was.
You know, you graduated from orthopedic residency,
You went into the community or you went
to an academic level level one center, and
the expectation was you were gonna fix fractures.
You were gonna take care of whatever came
in, regardless of of, your ability or your
experience level because as the on call doctor,
it was, quote, unquote, your responsibility.
I think what has happened in in groups
like the Orthopedic Trauma Association and the AO
Foundation have done a really good job of
educating
folks on how to fix fractures and how
to take care of patients who have traumatic
orthopedic injuries.
And then you've seen a growth of
orthopedic trauma fellowship trained traumatologists,
who have a a level of expertise in
fixing,
especially complex but even simple fractures.
And so this concept of, well, everybody can
do it or everyone should do it may
be a little bit,
historic.
And it and like I said, trauma is
not a recreational sport. And I think sometimes
what happens with
patients who come in who have really complex
injuries
or catastrophic injuries
is that there's a little bit of a
nihilistic approach to those patients. Like, well, you
have a really bad injury, so you're having
to have a really bad outcome. So sorry.
Right? It's sort of the same thing when
people have a cancer diagnosis. It's sort of
like, well, at least you're not dead. And
so it's sort of like, well but this
is a this is a solvable cancer. Right?
This is a solvable
complex problem
if solved by the person who has the
skill set to solve it. And so not
not every catastrophic injury has to have a
catastrophic outcome.
And I think that nihilistic view of, well,
you had a really bad trauma, so you're
gonna have a really bad outcome. I think
we have to get past that a little
bit. I do think that there is a
layer or level of expertise that an orthopedic
trauma surgeon can provide, and I'm excited to
see that people, I think, are starting to
to realize that.
We, you know, we have more and more
orthopedic surgeons who will reach out,
about complex cases. They will send a text
message or or something like that. I think
what we're seeing now is also as our
understanding of orthopedic trauma improves, we're seeing a
growth in, you know, things like mixed mixed
reality or augmented reality. You know, the the
ability to pre op plan using,
you know,
devices that