Latest / Becker’s Healthcare Podcast / Samir Mehta, MD, Chief of Orthopaedic Trauma & Fracture Service and Associate Professor of Orthopaedic Surgery at the University of Pennsylvania

Transcript

Samir Mehta, MD, Chief of Orthopaedic Trauma & Fracture Service and Associate Professor of Orthopaedic Surgery at the University of Pennsylvania · Becker’s Healthcare Podcast

• 0:00
  This is Laura Dirda with the Becker's Healthcare
• 0:02
  Podcast. I'm thrilled today to be joined by
• 0:04
  doctor Sameer Mehta, chief of orthopedic trauma and
• 0:07
  fracture service as well as associate professor in
• 0:09
  orthopedic surgery at University of Pennsylvania.
• 0:12
  Doctor Mehta, it's a pleasure to have you
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  on the podcast today.
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  Thanks for having me. Appreciate it.
• 0:17
  Absolutely. Now I'm excited for our conversation. I
• 0:19
  know a lot going on in orthopedics right
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  now, and we'll dig into a variety of
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  topics. But before we do, can you tell
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  us a little bit more about yourself and
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  University of Pennsylvania?
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  Sure. I've been in practice now for almost
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  nineteen almost, I guess, twenty years.
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  I do, orthopedic trauma. I have,
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  residents,
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  busy academic level one university,
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  center,
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  in a very busy academic department at Penn.
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  You know, we have obviously every service line
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  covered, within the university
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  ecosystem,
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  and our accessory referral center, for a variety
• 0:56
  of conditions including orthopedic trauma.
• 1:00
  Got it. That's helpful to know. Well, you
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  know, let's jump right in. Can you tell
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  us a little bit more more about some
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  of the trends you're watching currently? What's top
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  of mind for you in the orthopedic space?
• 1:09
  Yeah. So I think in orthopedics, there are
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  a couple of things. Obviously, my focus is
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  on orthopedic trauma.
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  And when we talk about trauma, we also
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  talk about fracture care.
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  And what's interesting
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  is the transition. And I haven't made it
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  yet, but I'm seeing it happen
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  in some of my colleagues
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  of fracture care transitioning to the ASD setting.
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  So, you
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  know, weekend warrior comes in with a broken
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  ankle.
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  They are splinted in the emergency room.
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  In some scenarios, they might get admitted and
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  operate on the next day. But if you
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  have a busy level one trauma center, you're
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  getting inundated with other more emergent or urgent
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  injuries,
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  and so it might be better served for
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  that patient to go home and then get
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  scheduled, quote, unquote, electively. I always sort of
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  joke around when I talk about it. They
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  joke around. I you know, it's always people
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  that say I do elective trauma. And they're
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  like, how do you have elective
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  trauma? The other term we use is cold
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  trauma. So you might get that ankle, which
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  has
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  a time component to it.
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  You know, you might do that ankle in
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  an ASC setting,
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  rather than bring them back to the trauma
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  center and take up a a spot in
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  the trauma OR.
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  And so while we haven't made that transition
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  yet, even though we have an ASC as
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  part of our, of our university hospital system,
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  that may be something that we are going
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  to start to employ,
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  especially to decompress our dizzy
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  trauma ORs within the hospital.
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  And I think that trend is actually happening
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  across the orthopedic crisis trend and move things
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  into the ASD setting in general. We're seeing
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  it with joints. We're seeing it with sports
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  medicine, obviously. We're seeing it with shoulder, arthroplasty,
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  and foot and ankle. And so,
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  trauma, which has historically been a more hospital
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  based
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  service line,
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  there are now opportunities
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  to to take that to the ASC for
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  these less
• 3:00
  emergent
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  but still time sensitive injuries.
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  That's helpful to understand. And, you know, definitely
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  a a lot going on, in that space.
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  And I'm curious,
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  how do you see some of these,
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  these issues? And and certainly,
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  folks coming in and needing,
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  you know, more care, from trauma really, you
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  know,
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  continuing to grow and evolve over time.
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  Yeah. So I think there are a couple
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  of things that I think are
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  really growing a lot. I think we're seeing
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  an an a tremendous increase
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  in geriatric
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  trauma.
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  You know, people are getting older. They're living
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  longer,
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  and we're seeing an explosion
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  on in terms of volume of
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  older people, maybe more frail people
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  breaking things, you know, beyond just the geriatric
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  hip fracture. Right? We hear about that a
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  lot. Our center, like many others, has a
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  geriatric hip fracture program.
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  But, really, what we're looking at is now
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  sort of a geriatric fracture program in general,
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  and our trauma team is seeing more and
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  more patients coming in general surgery trauma that
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  have geriatric
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  fractures. And and, unfortunately, the geriatric patient or
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  the frail patient has a different physiology
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  than, say, that 20 year old who's involved
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  in a high speed motor vehicle collision. Right?
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  They have a different physiologic reserve.
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  And so,
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  the geriatric patient, the the frail patients, the
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  elderly patients are coming in with polytrauma, the
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  broken arm, a broken leg, a broken ankle.
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  And, you know, that obviously, getting them up
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  and getting them mobilized is really critical. You
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  you know, making somebody who's in their eighties
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  non weight bearing
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  isn't really an option. I mean, think about
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  how hard it is to navigate on crutches.
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  You know, if you're young, imagine if you're
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  80 with a bad shoulder because you've got
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  a rotator cuff issue and now you're expected
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  to, you know, gimp around on crutches. It
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  it can be more dangerous
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  sometimes than just fixing the fracture and letting
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  patients walk immediately. And so, you know, we
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  have we have definitely evolved to a a
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  world where we are fixing more and more
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  geriatric fractures
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  And and even fractures that maybe historically we
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  would have treated conservatively or nonoperatively,
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  we're electing to
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  fix patients so we can mobilize them faster.
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  A classic one that I'm thinking about right
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  now aside from the geriatric hip fracture is
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  the geriatric pelvic fracture. Right? We are we
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  are getting a little bit more aggressive, more
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  pathway driven with those patients where, hey. If
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  they can't mobilize on a
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  what could be a nonoperative pelvis in a
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  day or two or three, then we should
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  fix them so they can then be aggressively
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  mobilized without fear or risk of
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  displacing their fracture.
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  So we are seeing more of the and
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  what's happening is these inpatient beds are being
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  taken up by these patients,
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  appropriately, and that transition for some of those
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  less urgent emergent cases can happen to the
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  ASC setting, and they can be discharged. So,
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  the volume of beds doesn't increase. Right? We
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  just have to figure out where to put
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  all the chest pieces.
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  That's helpful to understand. And, you know, really
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  kind of thinking through that process in in
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  workflows,
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  to make that work,
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  I I can imagine is easier said than
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  done. But,
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  just helpful to kind of get a a
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  behind the scenes look at, you know, how
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  things are,
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  how things are, you know, kind of flowing
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  and heading, what trends are top of mind
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  in your space. Now I'm curious what else,
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  you know, what are you focused on and
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  most excited about right now? What are you
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  really, looking into the future and saying that
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  you're excited for?
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  Yeah. I mean, I think there's a lot
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  on the horizon,
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  happening, in orthopedic
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  trauma and the fracture space. I think, you
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  know,
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  there's obviously,
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  you know, opportunities with things like biologics,
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  you know, in terms of how to get
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  fractures, you know, faster.
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  I think one of the things that we
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  are in 2026,
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  we're realizing is that, you know, fracture care
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  and trauma care is not a recreational
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  sport. You know, historically,
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  you know, everybody took call regardless of what
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  your specialty was.
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  You know, you graduated from orthopedic residency,
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  You went into the community or you went
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  to an academic level level one center, and
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  the expectation was you were gonna fix fractures.
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  You were gonna take care of whatever came
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  in, regardless of of, your ability or your
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  experience level because as the on call doctor,
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  it was, quote, unquote, your responsibility.
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  I think what has happened in in groups
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  like the Orthopedic Trauma Association and the AO
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  Foundation have done a really good job of
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  educating
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  folks on how to fix fractures and how
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  to take care of patients who have traumatic
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  orthopedic injuries.
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  And then you've seen a growth of
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  orthopedic trauma fellowship trained traumatologists,
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  who have a a level of expertise in
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  fixing,
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  especially complex but even simple fractures.
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  And so this concept of, well, everybody can
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  do it or everyone should do it may
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  be a little bit,
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  historic.
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  And it and like I said, trauma is
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  not a recreational sport. And I think sometimes
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  what happens with
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  patients who come in who have really complex
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  injuries
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  or catastrophic injuries
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  is that there's a little bit of a
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  nihilistic approach to those patients. Like, well, you
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  have a really bad injury, so you're having
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  to have a really bad outcome. So sorry.
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  Right? It's sort of the same thing when
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  people have a cancer diagnosis. It's sort of
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  like, well, at least you're not dead. And
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  so it's sort of like, well but this
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  is a this is a solvable cancer. Right?
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  This is a solvable
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  complex problem
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  if solved by the person who has the
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  skill set to solve it. And so not
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  not every catastrophic injury has to have a
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  catastrophic outcome.
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  And I think that nihilistic view of, well,
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  you had a really bad trauma, so you're
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  gonna have a really bad outcome. I think
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  we have to get past that a little
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  bit. I do think that there is a
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  layer or level of expertise that an orthopedic
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  trauma surgeon can provide, and I'm excited to
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  see that people, I think, are starting to
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  to realize that.
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  We, you know, we have more and more
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  orthopedic surgeons who will reach out,
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  about complex cases. They will send a text
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  message or or something like that. I think
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  what we're seeing now is also as our
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  understanding of orthopedic trauma improves, we're seeing a
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  growth in, you know, things like mixed mixed
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  reality or augmented reality. You know, the the
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  ability to pre op plan using,
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  you know,
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  devices that