The role of psychiatric status on pediatric extremity fractures: a prospective analysis

  • Altuğ Duramaz
  • Semra Yilmaz
  • Nezih Ziroğlu
  • Burcu Bursal Duramaz
  • Berhan Bayram
  • Tayfun Kara
Original Article



The aim of the study was to investigate the relationship between attention deficit and hyperactivity disorder (ADHD), anxiety, and depression with pediatric extremity fractures.


Between November 2014 and November 2016, consecutive 138 patients with pediatric extremity fractures were prospectively investigated in terms of the tendency to anxiety, depression, or ADHD in the study group. Consecutive 168 non-trauma patients who were admitted to general pediatrics outpatient clinic were included the control group. Patients were performed with Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parents Form (T-DSM-IV S), The Screen for Child Anxiety-Related Emotional Disorders (SCARED), and The Children’s Depression Inventory (CDI).


There were not any significant differences between study and control groups regarding the age, gender distribution, economical level, or previous psychiatric admission rates (p > 0.05). In the study group, the previous ADHD history and previous fracture history were significantly higher than the control group (p < 0.05). In the study group, the severity of depressive signs and anxiety were significantly higher than the control group (p = 0.000 and p = 0.019; respectively). Regarding the previous fracture history, conduct disorder and tendency to depression were significantly higher in the study group (p = 0.001 and p = 0.011; respectively).


The signs of ADHD, anxiety, and depression were determined to be higher in children with extremity fractures compared with the non-traumatic population. In patients with especially behavioral problems and depressive signs, directing to the child and adolescent psychiatrists will be protective to prevent re-fractures and high-energy traumas.


Pediatric extremity fractures Attention deficit and hyperactivity disorder Anxiety Depression 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Uslu M, Uslu R, Eksioglu F, Ozen NE. Children with fractures show higher levels of impulsive-hyperactive behavior. Clin Orthop Relat Res. 2007;460:192–5.PubMedGoogle Scholar
  2. 2.
    Uslu MM, Uslu R. Extremity fracture characteristics in children with impulsive/hyperactive behavior. Arch Orthop Trauma Surg. 2008;128:417–21.CrossRefPubMedGoogle Scholar
  3. 3.
    Wilkins KE, Aroojis AJ. Incidence of fractures in children. In: Beaty JH, Kasser JR, editors. Rockwood and Wilkins’ fractures in children. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 3–18.Google Scholar
  4. 4.
    Chou IC, Lin CC, Sung FC, Kao CH. Attention deficit/hyperactivity disorder increases risk of bone fracture: a population-based cohort study. Dev Med Child Neurol. 2014;56(11):1111–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Ozer K, Gillani S, Williams A, Hak DJ. Psychiatric risk factors in pediatric hand fractures. J Pediatr Orthop. 2010;30(4):324–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Erdogan M, Desteli EE, Imren Y, Yuce M, Buyukceran I, Karadeniz E. Is attention deficit and hyperactivity disorder a risk factor for sustaining fractures of proximal humerus. Acta Chir Orthop Traumatol Cech. 2014;81(3):221–6.PubMedGoogle Scholar
  7. 7.
    Shafiee-Kandjani AR, Noorazar SG, Aslanabadi S, Rashedi N, Dadkhah M, Jafarzadeh-Gharehziaaddin M. The relationship between attention-deficit/hyperactivity disorder and trauma in adolescents. J Emerg Pract Trauma. 2018;4(1):18–23.CrossRefGoogle Scholar
  8. 8.
    Bennett DS, Sullivan MW, Lewis M. Neglected children, shame-proneness, and depressive symptoms. Child Maltreat. 2010;15(4):305–14.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Schwebel DC, Roth DL, Elliott MN, Visser SN, Toomey SL, Shipp EM, et al. Association of externalizing behavior disorder symptoms and injury among fifth graders. Acad Pediatr. 2011;11(5):427–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Bruce BS, Ungar M, Waschbusch DA. Perceptions of risk among children with and without attention deficit/hyperactivity disorder. International journal of injury control safety promotion. 2009;16(4):189–96.CrossRefPubMedGoogle Scholar
  11. 11.
    Koyuncu A, Çelebi F, Ertekin E, Kök BE, Tükel R. Attention deficit and hyperactivity in social anxiety disorder: relationship with trauma history and impulsivity. ADHD Atten Def Hyp Disord. 2016;8(2):95–100.CrossRefGoogle Scholar
  12. 12.
    Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, et al. The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry. 1997;36:545–53.CrossRefPubMedGoogle Scholar
  13. 13.
    Kovacs M. The Children’s Depression Inventory (CDI). Psychopharmocol Bull. 1985;21:995–8.Google Scholar
  14. 14.
    Turgay A. Disruptive behavior disorders child and adolescent screening and rating scales for children, adolescents, parents and teachers. West Bloomfield: Integrative Therapy Institute Publication; 1994.Google Scholar
  15. 15.
    Ercan ES, Amado S, Somer O, Çıkoğlu S. Dikkat eksikliği hiperaktivite bozukluğu ve yıkıcı davranım bozuklukları için bir test bataryası geliştirme çabası. Çocuk ve Gençlik. Ruh Sağlığı Dergisi. 2001;8(3):132–44.Google Scholar
  16. 16.
    Hesapçıoğlu ST, Tural MK, Kandil S. Quality of life and self-esteem in children with chronic tic disorder. Turk Pediatri Ars. 2014;49(4):323–32.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Öy B. Çocuklar İçin Depresyon Ölçeği: Geçerlilik ve güvenirlik çalışması. Turk Psikiyatri Derg. 1991;2:132–6.Google Scholar
  18. 18.
    Merrill RM, Thygerson SM, Palmer CA. Risk of injury according to attention deficit hyperactivity disorder, comorbid mental illness, and medication therapy. Pharmacopsychiatry. 2016;49(02):45–50.CrossRefPubMedGoogle Scholar
  19. 19.
    Larson K, Russ SA, Kahn RS, Halfon N. Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics. 2011;127:462–70.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Merrill RM, Lyon JL, Baker RK, Gren LH. Attention deficit hyperactivity disorder and increased risk of injury. Adv Med Sci. 2009;54:20–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Ertan C, Özcan ÖÖ, Pepele MS. Paediatric trauma patients and attention deficit hyperactivity disorder: correlation and significance. Emerg Med J. 2012;29(11):911–14.CrossRefPubMedGoogle Scholar
  22. 22.
    Brault MC, Lacourse É. Prevalence of prescribed attention-deficit hyperactivity disorder medications and diagnosis among Canadian preschoolers and school-age children: 1994–2007. Can J Psychiatry. 2012;57(2):93–101.CrossRefPubMedGoogle Scholar
  23. 23.
    Yousefichaijan P, Sharafkhah M, Rafiei M, Salehi B. Attention-deficit/hyperactivity disorder in children with overactive bladder; a case-control study. J Renal Inj Prev. 2016;5(4):193–9.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Altuğ Duramaz
    • 1
  • Semra Yilmaz
    • 2
  • Nezih Ziroğlu
    • 1
  • Burcu Bursal Duramaz
    • 3
  • Berhan Bayram
    • 1
  • Tayfun Kara
    • 2
  1. 1.Department of Orthopedics and TraumatologyBakırköy Dr. Sadi Konuk Education and Research HospitalBakırköyTurkey
  2. 2.Department of Child and Adolescent PsychiatryBakırköy Dr. Sadi Konuk Education and Research HospitalBakırköyTurkey
  3. 3.Department of Pediatric Infectious DiseasesBezmiâlem Vakıf UniversityFatihTurkey

Personalised recommendations