Geriatric Orthopedic Specialist

Educational Objectives

The goal of this program is to increase awareness about geriatric fractures. After hearing and assimilating this program, the clinician will be better able to:

1. Discuss the need for comprehensive training to manage geriatric fracture patients.

Summary

Background: emerging role for specialist who treats geriatric patients; increasing numbers of complex fractures with poor bone quality in elderly, frail patients; these patients make up 13% of population but 25% of trauma admissions; consume one-third of trauma care resources; >20% of population will be >65 yr of age within next 25 yr

Patient issues: medical comorbidities; limited surgical reserve (consider staged surgery); need for rehabilitation; poor soft tissue envelope with very thin skin; poor healing; poor bone quality (limits reduction, fixation, and ability to maintain fixation); limitations on rehabilitation; 3 to 4 times more likely to require blood transfusion with pelvic fracture than younger patients; significant increase in mortality

Surgeon training: skill set not keeping up with trends; current training system “siloed” (little interaction between societies); little cross-training in advanced techniques

Fellowship training: trauma — manage polytrauma, complex periarticular fractures, pelvic and acetabular fractures, malunion, nonunion, and amputations; arthroplasty — pelvic discontinuity; revision arthroplasty; use of bulk allograft; shoulder and elbow — total shoulder replacement; reverse total shoulder replacement; total elbow replacement; rotator cuff tears; foot and ankle — amputations; arthrodesis; diabetic foot disease; limb salvage; unmet needs — management of severely osteoporotic bone; management in presence of metabolic bone disease; comprehensive medical co-management; developing and managing geriatric fracture programs; speaker believes training should be combined to better serve needs of patients

Readings

Altman RD et al: Assessment of clinical practice guideline methodology for the treatment of knee osteoarthritis with intra-articular hyaluronic acid. Semin Arthritis Rheum, 2015 May;[Epub ahead of print]; Aw D, Sahota O: Orthogeriatrics moving forward. Age Ageing, 2014 May;43(3):301-5; Bender JS, Meinberg EG: Fragility fracture programs: are they effective and what is the surgeon’s role? Curr Osteoporos Rep, 2015 Feb;13(1):30-4; Griffin DR et al: Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J Orthop Trauma, 2006 Jan;20(1 Suppl):S30-6; Jevsevar DS, Bozic KJ: Orthopaedic healthcare worldwide: Using clinical practice guidelines in clinical decision making. Clin Orthop Relat Res, 2015 May;[Epub ahead of print]; Lin C et al: Functional outcomes after total hip arthroplasty for the acute management of acetabular fractures: 1-to 14-year follow-up. J Orthop Trauma, 2015 Mar;29(3):151-9; Litrenta J et al: Does syndesmotic injury have a negative effect on functional outcome? A multicenter prospective evaluation. J Orthop Trauma, 2015 Jan;[Epub]; Matta JM: Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am, 1996 Nov;78(11):1632-45; Odak S et al: Management of posterior malleolar fractures: a systematic review. J Foot Ankle Surg, 2015 Jun;[Epub]; Osterhoff G et al: Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications. Arch Orthop Trauma Surg, 2011 Jun;131(6):809-13; Poolman RW et al: From evidence to action: understanding clinical practice guidelines. Acta Orthop, 2009 Feb;80(1):113-8; Porter SE et al: Acetabular fracture reduction in the obese patient. J Orthop Trauma, 2011 Jun;25(6):371-7; Porter SE et al: Complications of acetabular fracture surgery in morbidly obese patients. J Orthop Trauma, 2008 Oct;22(9):589-94; Pyon EY: Primer on clinical practice guidelines. J Pharm Pract, 2013 Apr;26(2):103-11; Sanders JO et al: Clincial practice guidelines: Their use, misuse, and future directions. J Am Acad Orthop Surg, 2014 Mar;22(3):135-44; Saterbak AM et al: Clincial failure after posterior wall acetabular fractures: the influence of initial fracture patterns. J Orthop Trauma, 2000 May;14(4):230-7; Tannast M et al: Two- to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg Am, 2012 Sep;94(17):1559-67; Van Schie-Van der Weert EM et al: Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures. Arch Orthop Trauma Surg, 2012 Feb;132(2):257-63.

Disclosures

In adherence to ACCME Standards for Commercial Support, Audio-Digest requires all faculty and members of the planning committee to disclose relevant financial relationships within the past 12 months that might create any personal conflicts of interest. Any identified conflicts were resolved to ensure that this educational activity promotes quality in health care and not a proprietary business or commercial interest. For this program, members of the faculty and planning committee reported nothing to disclose.

Acknowledgements

Dr. Meinberg was recorded at the 10th Annual International Orthopaedic Trauma Course, presented by the University of California, San Francisco, Department of Orthopaedic Surgery, and held April 30 to May 2, 2015, in San Francisco, CA. For information on future CME events from UCSF, visit www.cme.ucsf.edu. The Audio Digest Foundation thanks the speakers and University of California, San Francisco, Department of Orthopaedic Surgery, for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

OR381706

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.