Significant Orthopedic Trauma Can Trigger Post-Traumatic Stress Disorder

Although most commonly associated with military combat, post-traumatic stress disorder (PTSD) can occur in civilians — with consequences that are just as serious, according to a new review article in the Journal of the American Academy of Orthopaedic Surgeons. PTSD is a type of anxiety disorder that occurs after a person experiences a traumatic event involving physical injury, and occurs in 20% to 51% of patients with an orthopedic injury.

“PTSD occurs with a significant frequency in civilian patients who have sustained an orthopedic trauma and it can hinder their emotional, physical and functional recovery following orthopedic treatment,” Daniel Aaron, MD, clinical instructor in the department of orthopaedics at Brown University, stated in a press release.

Many types of accidents can cause PTSD, including car or motorcycle accidents, gunshot wounds, vehicle-pedestrian accidents and falls from height.

“Generally, higher-energy mechanisms are most commonly associated with PTSD, but no specific type of fracture or injury has been identified,” Aaron stated. “Basically, any type of musculoskeletal injury that results from significant trauma may be associated with PTSD.”

PTSD can have a significant impact on a patient’s ability to perform simple, daily chores and can slow the rehabilitation process, even affecting how the patient experiences pain and perceives his or her recovery.

A diagnosis of PTSD relies on the presence of specific behaviors or symptoms, including:

  • Re-experiencing the traumatic event, including nightmares, flashbacks and intrusive memories;
  • Avoiding situations reminiscent of the original trauma, reluctance to talk or think about the original trauma, or feeling emotionally “numb” about the event; and
  • Anger, irritability, difficulty concentrating, insomnia and/or an increased startle response.

Treatment of PTSD begins with referral to a psychiatric professional, who may prescribe medication and implement a behavioral therapy program to help deal with the traumatic event and its effects. Although PTSD clearly impacts recovery in patients with orthopedic injury, currently there are no studies that directly link treatment or resolution of PTSD with orthopedic improvement and many of the options for treatment of PTSD are in the experimental stage, according to Aaron.

“In addition to continuing to look at treatment options and their effects, we need to study the effectiveness of prevention strategies,” he stated. “And we also need to look at whether physical and functional outcomes do indeed improve as the emotional symptoms of PTSD are treated.”

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