Broken Bones, Broken Lives? | Orthopedics This Week

Broken Bones, Broken Lives?

Source: Wikimedia Commons and Kavel

If you look only at the broken bone, you miss the whole picture, says new work from the University of Florida (UF) in Gainesville.

The study, “Patient-Reported Outcomes Measurement Information System Outcome Measures and Mental Health in Orthopaedic Trauma Patients During Early Recovery,” appears in the September 2018 edition of the Journal of Orthopaedic Trauma. This work was a secondary observational analysis from a randomized controlled study performed at a Level-1 trauma center. The study investigators followed a total of 101 patients from acute care to week 12 post-discharge.

Co-author Heather K. Vincent, Ph.D., with the UF Health Orthopaedics and Sports Medicine Institute explained the purpose of the study to OTW, “In the orthopedics trauma setting, patients are suddenly thrust into a scenario they never intended: a car accident, serious fall, assault or a blunt force incident. In a split second, their lives are changed forever.”

“Some face multiple fractures, amputations, have serious internal and orthopedic injuries that leave them bedridden for a while. Their lives are interrupted, and they have no control over their daily activities and they are worried about child care, eldercare, taking care of pets and the home, losing a job, paying bills and so on.”

“While surgical care is the first process they experience to mend the bones and joints, they are left with lingering psychological and social challenges especially after discharge.”

“Anecdotally, we have observed that the most challenging time for patients is after discharge when they leave the busy environment of the hospital and go home (usually 2-12 weeks). At this time, they have a much better understanding of their limitations and mental stress develops (depression, anxiety) and perceptions of satisfaction about themselves seems to worsen.”

“Within the first three months after surgical repair from orthopedic trauma injury, even among patients with no documented psychiatric conditions (like depression, anxiety) there is a relatively significant portion who develop depressive and anxious symptoms quickly after injury.”

“These patients self-report improvement in physical aspects of recovery similar to people without depressive or anxiety symptoms. But, these same patients report feeling worse about their psychosocial health and life aspects. This means we cannot assume that because a patient reports that their muscles and bones are feeling better, that they are actually fully recovered. There is a lasting scar mentally that prevents survivors from fully re-engaging back in life even as the physical body is healing.”

“Some patients who display higher anxiety or depression symptoms may need some tailored psychosocial support or an empathetic ear by the care team. Some opportunities could be peer support (by pairing up trauma survivors to help their peers navigate the process and answer questions or be a sounding board) engagement in social media outlets (seeing others who have gone through similar emotions and challenges may reduce feelings of isolation or anger) and providing resource avenues to help patients reduce stress (websites or contacts for pet care assistance, eldercare assistance for parents in the home, meals on wheels).”

“Clinicians need to think about the patient as a whole, not a ‘fracture case’ or ‘pelvic ring repair that needs to be discharged to rehab.’ Patients with orthopedic trauma are facing a major life change and this process of recovery extends far after the bones have been reduced and the joints are repaired. One does not need to be a psychologist or psychiatrist to validate feelings of anxiety or sadness or depression. Sometimes the simple acts of 1) asking how the patient is coping and is there anything else you can do in the hospital or at follow-up, and 2) verbalizing understanding of hardship allows the patient to feel acknowledged, valued and listened to.”


16 thoughts on “Broken Bones, Broken Lives?

  1. My son had a broken wrist from riding his bike into the garage door. It really put a damper on his activities. It was a major life change for him while the cast was on his arm. Thanks for your interesting post.

    Teri Green
    Atlas Biomechanics

  2. I broke my wrist a few months ago, and I just got my pins out. I was thinking to myself about how angry and depressed I’ve been lately, and I wondered if there was something to it. So I did a search about broken bones and depression and found this article. Thanks for this. It helps me know that it’s not just me going crazy. This is real.

  3. I was pulled from a fiery car crash. 5 broken ribs, right femur broken in 2 places, 5 brakes in my tibea and the list goes on. SO many people commented on what they imagined my physical pain must be. But my mental anguish confusingly dwarfed my physical pain. I was concerned I had lost my mind in the crash as well. I was very relieved to read this article and find maybe there was other explanations! Thank you.

    1. I’m happy you’re doing better. My partner just had an accident with similar injuries. I want to help him mentally. Is there anything you can share that helped you mentally recover?

  4. I had an accident from saving my little brother falling when we were skating, i broke my right tibia-fibula. at first i was very optimistic on my hospitalization, but when i went home and weeks and months after recovery i experienced depression since all my goals and achievments were left behind. i was a working student to pursue my doctoral program and because of my accident i was delayed and all my workload papers requirements were stacking up, and pressure on me everyday was increasing. i was looking for a study similar. thanks for this info

  5. Thank you all for your comments. My partner just had an accident and has his leg broken in 3 places and 2 broken ribs. I am trying to find out the best way to support him mentally while he recovers. Is there anything that worked for you guys. I was glad to see Rob’s and KZ’s post. If you or anyone else who has been through this sees this post, can you tell me what helped you in your recovery mentally?

  6. 5 surgeries in three years but a fall – an acute distal radius fracture with orif surgery has taken me down. I think you lose your resilience after awhile and my partner is fine but fed up- which makes things worse. I was Indepedent before but had two spine surgeries beforehand and 2 unexpected stomach surgeries. I hear Ketamine can help. I am open to this.

  7. I thought I was the only one. Feel very depressed after two fibula fractures. After 8 weeks & a CAM boot, still unable to walk very well. Currently transitioning out of CAM boot. Feel like the medical “professionals” (I use that term loosely) did not accurately inform me about how long I would be NWB, the “real” time in the CAM boot. I currently limp and am not sure if it will be permanent. Feel very down and no real answers or help.

  8. I had a distal radius wrist fracture 8 weeks ago.As a pianist this has been devastating and I have felt very low mainly through not knowing I can regain full range of movementI also have ligent damage which will may take a lot longer to heal.I can really sympathise with how you all feel.

  9. Thanks for publishing this. Three weeks after fracturing my wrist I’ve learned I will need surgery, and have a much longer recovery schedule. The ongoing discomfort, the lack of good sleep, and the loss of ground at work and at home have got me pretty down. It helps yo know this is not uncommon.

  10. I am so relieved to see this. I’ve been lying in bed and watching stupid videos, I have no motivation, and it is completely out of character for me. My broken wrist is healing well, but I just feel listless. I appreciate everyone’s comments here and I hope you are all doing better.

  11. I experienced a trimalleolar fracture and dislocation of my right ankle in late July this year. Almost 12 weeks later I’m still using crutches and wearing a boot. I’ve completely lost the desire to do normal daily activities, and I have no idea when I’ll be able to walk unassisted.
    I’ve been unable to perform my previous job, which requires standing for a large portion of the day, so I have lost that as well. I can only hope I can find a light at the end of the tunnel

  12. I fractured my front pelvic bone about 4 weeks ago. I want to cry every day. I sometimes wait till I’m alone and just howl. I used to be such an upbeat person, I don’t understand these feelings.

  13. I suffered a closed displaced Trimalleolar fracture of the right ankle in early May of this year. Just passed week 8 post surgery and my trauma surgeon gave me the clearance to start walking, PT. I still have moments when I think about my fall and holding my broken ankle in place for 2 hours in the ER, even dream about it. I have never felt anxious before in my life but I am paranoid about falling and breaking another bone again. I’m glad I read everyone’s experiences and know I’m not going crazy.

  14. I moved from Dallas to Philly, and found a great job working at the Post Office. I broke my fibula on my second day of training delivering mail. It created a snowball effect because I lost my job (you can be fired for anything within your first 90 days) and I’m out of work for at least 6 weeks. It happened at work so luckily im compensated for it but I will need to find a job so I can keep up with bills. I just moved here so the only thing I have in my apartment is a air mattress. I’m a very active person so sitting here really hurts my mental. Knowing that I could’ve been at work really hurts my mental. Not being mobile in a brand new city and not knowing anyone is something I just can’t explain. I can’t believe this is my life right now

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