AAOS – 1 – Treat the Patient as well as the Fracture
The bone was mush. Pinning that hip fracture successfully took all the skill gained in years of surgeries. Sneaking this surgery in before office has made you late (again). Write orders, dictate the report, a quick word with the family, and…….Stop! Tell the family that the bone was mush! Add the diagnoses of Osteoporosis and Fragility Fracture! Treat the whole patient!
The post op discussion is a valuable teachable moment. You have the full attention of this patient’s support team. They need to know that dealing with the osteoporosis could prevent having to deal with breaking the other hip within the year. A full discussion of osteoporosis can wait, but they need to know that a full discussion is needed with you or with the healthcare provider to whom you refer this problem in this patient.
Write and dictate the diagnoses of Osteoporosis (733.00) and Fragility Fracture (733.10). You know what the inside of the bone was like. If you don’t place the right diagnoses in the chart, who will? Nationally we still identify far less than half of the osteoporotic hip fractures, and far fewer osteoporotic wrist, shoulder, ankle, pelvis and vertebral fractures as “osteoporosis”.
All you need to do is tell the family (and later the patient), put the diagnosis in the chart, and arrange for someone to treat the osteoporosis. You do not need to treat osteoporosis yourself IF you have someone else lined up to do it. If you have no-one lined up, stop by the “Own the Bone” booth in the exhibit hall. They can help you. See www.OwnTheBone.org.
We are the “bone docs.” Patients are twice as likely to follow through with osteoporosis treatment if their orthopedic surgeon tells them it is important. Treat the whole patient, not just the fracture.
Jay Ginther, MD, FAAOS