Moderator Thornhill: List for me what goes through your mind in the case of a 65-year-old person —open reduction internal fixation [ORIF] by any of a number of newer means or hemi, shoulder, reverse, or just watchful neglect. How does that pare down for you?
Dr. Flatow: I think if you have an older patient, 70s or 80s with poor bone and little tiny shelves of tuberosities, those we go for reverse and I think that’s pretty clear from the record. I think if you have a 4-part impacted valgus fracture that has the medial hinge, I’ll pin everyone of those no matter what the age is. I think those do very well. The few that get AVN, you can always go back and do a hemi. I think if there is a younger patient with good bone, I’ll debate between a hemi and internal fixation. And that’s individualized in each case.
Moderator Thornhill: Leesa, it’s interesting the incidence of reverse shoulder has really skyrocketed. What do you think is driving that? Is it because it’s better, it’s more available, it’s more reimbursed, it’s a quicker fix in a short period of time?
Dr. Galatz: I think it’s a couple of things. Number 1 is that when you have an older person with a problem—let’s say a fracture—and you try to fix it, it is a long rehabilitation. With a reverse you can stabilize a shoulder enabling elderly patients to mobilize very quickly. We know that elderly patients need a lot of rehabilitation and that just kind of sucks the energy out of them and they develop other problems. We want to fix them and get them back up. A reverse allows us to do that.
I also think the techniques are getting easier. We’re better at teaching people how to do it. It offers a solution where we didn’t have one for some very, very difficult problems. Again, just like fixing a hip fracture in an elderly person, we can stabilize a shoulder, and allow them to weight bear on a walker, a cane or whatever they have. It’s an important thing.
Moderator Thornhill: Well, it’s a wonderful debate. Let’s thank our debaters.
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