NEW ORLEANS 3/6/2003 - Post-traumatic stress disorder (PTSD), a psychological condition initially described as affecting combat veterans who have suffered severe emotional or physical trauma, is now being recognized in orthopaedic trauma patients, according to results of a study presented at the American Academy of Orthopaedic Surgeons' (AAOS) 70th Annual Meeting. To date, there had been no study of the prevalence of PTSD in orthopaedic trauma patients. However, because serious extremity injury is known to have a negative impact on quality of life, this investigation was conducted to determine the prevalence of PTSD in orthopaedic trauma cases.

Research in other medical disciplines has shown that psychological disturbance can have a profound negative impact on outcome. This study indicates that PTSD after orthopaedic trauma is, in fact, very common. Orthopaedic surgeons are presently finding that in order to treat an injury, it is imperative to treat the whole person and to be aware of any other conditions that will affect orthopaedic trauma recovery. "Any illness or psychological disturbance that has a substantial negative impact on outcome after trauma cannot be ignored. In some cases, post-traumatic psychological illness may have a stronger effect on outcome than the severity of the injury itself," according to Adam J. Starr, MD, principal investigator of the study and Assistant Professor of Orthopaedic Surgery at the University of Texas Southwestern Medical Center in Dallas, Texas.

Symptoms of PTSD are divided into three categories: intrusion symptoms, such as recurring recollections of the event; avoidance symptoms, such as efforts to avoid certain activities, places or thoughts related to the event; and arousal symptoms, such as excessive vigilance, outbursts of anger, or sleeplessness. The Diagnostic and Statistical Manual of Mental Disorders specifies that to merit a diagnosis of PTSD, patients must show a specific number of symptoms in each category. This was determined from the patients' answers to the questionnaire used in this study, which incorporated questions for each of the three categories. Positive responses to a certain number of questions in each category determine the PTSD diagnosis.

This study found that 52% of the orthopaedic trauma patients who answered the questionnaire met the criteria for a diagnosis of PTSD. These patients also had significantly higher injury severity scores. Contrary to expectation, more elapsed time since injury seemed to raise the risk of PTSD rather than decrease it.

The study consisted of 330 orthopaedic trauma follow-up patients with various injuries who completed the questionnaire. Causes of patient injuries included in the study were motor vehicle collision, motor-pedestrian collision, motorcycle collision, crush injuries, horseback riding injuries, and gunshot wounds. The average injury severity score was 8.3, with a range from 1 to 36. The average time elapsed since injury was 14 months. The questionnaire used in this study was the Revised Civilian Mississippi Scale for PTSD, a self-report questionnaire that is widely used in the mental health industry. The investigative team created one additional question asking whether emotional aspects caused by the injury were more difficult to cope with than the physical problems.

The 26,047-member American Academy of Orthopaedic Surgeons (www.aaos.org) or (http://orthoinfo.aaos.org ), is a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals and the public. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade (http://www.usbjd.org ),the global initiative in the years 2002-2011 to raise awareness of musculoskeletal health, stimulate research and improve people's quality of life. President Bush has declared the years 2002-2011 National Bone and Joint Decade in support of these objectives. The Academy's Annual Meeting is being held February 5-9, 2003, at the Ernest N. Morial Convention Center

---American Academy of Orthopaedic Surgeons