The mind continues to matter: psychologic and physical recovery 5 years after musculoskeletal trauma.

OBJECTIVES: Posttraumatic psychopathology may complicate recovery from musculoskeletal injury. This article details the 5-year follow-up of a cohort study examining the relationship between posttraumatic psychopathology and recovery after musculoskeletal trauma. DESIGN: A prospective cohort study of patients with musculoskeletal injuries (Grampian Trauma Outcomes Study) assessed 5 years after their injury. SETTING: Orthopaedic trauma unit, Level I equivalent. PATIENTS: One hundred four of the initial group of 200 patients with musculoskeletal injuries. INTERVENTION: Trauma care and prospective evaluation of physical and psychologic recovery. MAIN OUTCOME MEASURES: Development of psychopathology (measured by the General Health Questionnaire [GHQ]) and functional outcome (measured by Short Form-36 [SF-36] and Musculoskeletal Function Assessment [MFA]). RESULTS: Follow-up at 5 years was 104 patients (52%). GHQ caseness was predictive of physical dysfunction (SF-36, MFA), which had not returned to baseline levels by 5 years. Although injury severity was strongly predictive of psychological disturbance (GHQ caseness) at 5 years, linear regression analysis demonstrated that GHQ score was an important predictor of outcome, whereas Injury Severity Score contributed very little. CONCLUSIONS: Psychologic disturbance after musculoskeletal trauma is related to adverse functional outcome. This is not influenced by preinjury state, but constitutes a sustained posttraumatic effect that is only weakly related to severity of injury.

Proinflammatory markers in prediction of posttraumatic psychological symptoms: a prospective cohort study.

INTRODUCTION: Posttraumatic psychopathology (PTP) describes the spectrum of conditions that can complicate the recovery from commonly occurring musculoskeletal trauma. There is a clear association with the activation of the hypothalamic-pituitary-adrenal axis (HPAA), and we wished to examine the predictive value of proinflammatory markers of the HPAA and of the GABA, which acts as an inhibitory regulator. METHODS: Levels of proinflammatory markers and GABA were measured in 84 patients who had suffered musculoskeletal injuries requiring hospitalisation. PTP was assessed by the use of the General Health Questionnaire (GHQ) at presentation and again at two- and six-month reviews. RESULTS: Significant psychological disturbance was noted in 39% of patients at two months and falling back to 18% by six months. There was no correlation between any of the markers tested at presentation and PTP at follow-up. DISCUSSION: The HPAA response to trauma and the development of PTP are extremely complex. It is unlikely that a simple blood assay will provide significant predictive information, while incident specific information and patient perception are of more practical use.

The mind does matter: Psychological and physical recovery after musculoskeletal trauma.

BACKGROUND: Posttraumatic psychopathology (PTP) is important to the orthopedic surgeon because it appears to be much more common than might have been suspected and may complicate the recovery from musculoskeletal injury. We have investigated the relationship between physical and psychological recovery in victims of musculoskeletal trauma. METHODS: A prospective cohort of 200 patients with musculoskeletal injuries were studied, correlating development of psychopathology (measured by the General Health Questionnaire) and functional outcome (measured by Short Form-36, Sickness Impact Profile, and Musculoskeletal Function Assessment) 2 and 6 months after their injuries. RESULTS: Pre-existing psychological disturbance was found in 11% of our patients; this figure rose to 46% of patients at 2 months but fell to 22% at 6 months. The posttraumatic disturbance correlated strongly with impaired functional outcome as measured by all three outcomes measures (total and category scores) (p < 0.05). CONCLUSIONS: The strong correlation of PTP with impaired functional outcome after musculoskeletal trauma stresses that it is a significant problem. Further research is required to determine whether an approach that combines physical and psychological treatment can improve patient outcomes.

Proximal femoral geometry and hip fractures.

There is increasing evidence that proximal femoral geometry has an important role in the aetiology of hip fractures. We performed a simple radiological study to investigate the relationship between proximal femoral geometry and intracapsular and extracapsular fractures of the proximal femur. Measurements of proximal femoral geometry were made on pelvic radiographs on the contralateral hip of 50 consecutive patients with intracapsular and 50 with extracapsular fractures. The groups were matched for age and sex with a mean age of 79 and a female :male ratio of 4 :1. There were no statistical differences in head diameter, neck width or Head Trochanter Length between the two groups of fractures. Hip Axis Length, neck length and the neck length :width ratio were significantly greater in the intracapsular group, suggesting an aetiological link. This may have implications for future screening and prevention of proximal hip fractures, particularly intracapsular fractures.