Orthopaedic and Geriatric Teams Focus on Caring for Fragile Bones
Fractures are common among the elderly and as the population ages, the incidence of breaking bones increases. At MedStar Good Samaritan Hospital, we use a team approach to provide the best care for this population through our Ortho-Geriatric Service. “Our Ortho-Geriatric Service is a multidisciplinary way of managing the medical needs of elderly patients admitted for fractures and other orthopaedic conditions. Our geriatric team partners with the orthopaedic, nursing and rehabilitation teams to achieve the best function and outcomes for these often-frail patients,” explains George Hennawi, MD, chief of Geriatrics at MedStar Good Samaritan and director of the Center for Successful Aging. “Simply fixing a fracture or joint problem does not address the reason a fall or a problem occurred. In the case of a fracture, identifying the underlying cause can help us to minimize the chances of that patient having a repeat episode,” he adds.
When 79-year-old Marie Kelly fell and fractured her hip while cleaning her house, the ortho-geriatric team was there for her every step of the way. “Hip injuries can be dangerous for the elderly. Older patients have a higher risk of complications, and many need treatment beyond surgery,” says Carmen Pichard-Encina, MD, an orthopaedic surgeon with MedStar Orthopaedic Institute who cared for Kelly. “The fact that Marie had previous fall-related injuries was a red flag that she had other medical conditions. Prior to her hip surgery, we met with members of our geriatrics team and her family to evaluate her medical, cognitive and emotional status so a personalized geriatric-based plan could be developed. This helped to ensure she would have a successful recovery.” Kelly was wheeled into surgery less than 24 hours after being admitted to MedStar Good Samaritan. This is one of the goals of the program. “Reducing delays before surgery reduces complications and results in better outcomes, as well as a shorter hospital stay,” Dr. Pichard-Encina notes.
After her surgery, Kelly spent two days in the orthopaedic surgical unit then completed inpatient rehabilitation. She was home in two weeks. During her stay, Malek Cheikh, MD, an endocrinologist who specializes in caring for patients with osteoporosis, began working with Kelly and her family. They created a plan to prevent future fractures and improve both her short- and long-term outcomes. Dr. Cheikh also scheduled her for a visit to the Center for Successful Aging, which provides care for older patients with complex medical and social conditions.
There, the first step was a bone density test, called a DEXA scan, to determine if she had osteoporosis. Osteoporosis is a debilitating disease common in elderly women in which the bones become fragile and are more likely to break. Kelly’s test showed that she had experienced significant bone loss. Dr. Cheikh explains, “We are taking steps to slow the bone loss, increase her bone density and reduce her risk of fractures in the future. Dietary changes, appropriate exercise and medication are all essential to this. Making sure her home environment is safe and as fall proof as possible is important too.”
Today, Kelly is on the mend and her family is grateful for the integrated care she received at MedStar Good Samaritan. “Falls and fractures go hand-in-hand with aging and are extremely common. That’s why we don’t just patch up a fractured hip and send a patient home. When a geriatrician cares for a patient in concert with an orthopaedic surgeon, the results are much better,” Dr. Hennawi adds.”
This article appeared in the summer 2017 issue of Good Health. Read more articles from this issue.