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Becker’s Healthcare Podcast
Samir Mehta, MD, Chief of Orthopaedic Trauma & Fracture Service and Associate Professor of Orthopaedic Surgery at the University of Pennsylvania
00:09:31
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- [00:00]
A
This is Laura Dardo with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. Samir Mehta, Chief of orthopedic trauma and Fracture service, as well as associate professor in Orthopedic surgery at the University of Pennsylvania. Dr. Mehta, it's a pleasure to have you on the podcast today.
- [00:15]
B
Thanks for having me. Appreciate it.
- [00:17]
A
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?
- [00:28]
B
Sure. I've been in practice now for almost 19, almost, I guess 20 years. I do orthopedic trauma. I have residents, Busy Academic Level 1 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 tertiary referral center for a variety of conditions, including orthopedic trauma.
- [01:01]
A
That's helpful to know. Well, you know, let's jump right in. Can you tell us a little bit more about some of the trends you're watching currently? What's top of mind for you in the orthopedic space?
- [01:10]
B
Yes, 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 with some of my colleagues of fracture care transition to the AFC 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. They joke around. It's always people I say, I do elective trauma. And they're like, how do you have elective trauma? The other term we use is pulled trauma. 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 spot in the trauma ORs. And so while we haven't made that transition yet, even though we have an ASP as part of our university hospital system, that may be something that we're going to start to employ especially to decompress our busy trauma ORs within the hospital. And I think that trend is actually happening across orthopedics. Right. This trend to 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 take that to the ASC for these less emergent but still time sensitive injuries.
- [03:05]
A
That's helpful to understand and you know, definitely a lot going on in that space. And I'm curious, how do you see some of these issues and certainly folks coming in and meeting, you know, more care from trauma really continuing to grow and evolve over time.
- [03:26]
B
Yeah, so I think there are a couple of things that I think are really growing a lot. I think we're seeing a tremendous increase in geriatric trauma. People are getting older, they're living longer and we're seeing an explosion in terms of volume of older people, maybe more frail people breaking things beyond just the geriatric hip fracture. 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 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 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 patients, the frail patients, the elderly patients are coming in with polytraumas, a broken arm, a broken leg, a broken ankle. And you know, that obviously getting them up and getting them mobilized is really critical. You know, making somebody who's in their 80s non weight bearing isn't really an option. I mean, think about how hard it is to navigate. You know, if you're young, imagine if you were 80 with a bad shoulder because you've got rotator cuff issues and now you're expected to, you know, gimp around on crutches. 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 world where we are fixing more and more geriatric fractures and even fractures that maybe historically we would have treated conservatively or non operatively. We're electing to fix patients so we can mobilize them faster. The 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 non operative 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. The volume of beds doesn't increase. Right. We just have to figure out where to put all the chest pieces.
- [06:07]
A
That's helpful to understand and, you know, really kind of thinking through that process in workflows to make that work. I can imagine is easier said than done, but just helpful to kind of get 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?
- [06:37]
B
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 heal 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 going to fix fractures, you were going to take care of whatever came in, regardless of, of your ability or your experience level. Because at the on call, doctor, it was, quote, unquote, your responsibility. I think what has happened and 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 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 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 going to have a really bad outcome. So, sorry, right. It's the same thing when people have a cancer diagnosis. It's 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 going to 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 realize that we have more and more orthopedic surgeons who will reach out about complex cases, they will send a text message 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 reality or augmented reality. You know, the, the ability to pre op plan using, you know, devices that allow.