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The association of pre-existing mental health conditions and patient outcomes after lower extremity orthopaedic trauma: a scoping review

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Existing research has established a correlation between post-traumatic mental health conditions, including anxiety and depression, and various aspects of recovery, such as pain exacerbations, reduced functional recovery, and lowered patient satisfaction. However, the influence of pre-existing mental health conditions on orthopaedic trauma outcomes has not been thoroughly investigated. The objective of this study was to systematically review literature addressing the association between pre-existing mental health conditions and patient outcomes following surgical interventions for lower extremity fractures in non-geriatric populations.

Methods

A systematic literature review was conducted using Medline, Embase, and Scopus databases following PRISMA-ScR guidelines to select studies that examined lower extremity orthopaedic trauma outcomes in relation to pre-existing mental health conditions. Studies that evaluated patients with surgically treated lower extremity fractures and a history of mental health conditions such as anxiety, depression, or mood disorders were included. Studies with a mean patient age above 65 years of age were excluded to focus on non-geriatric injury patterns.

Results

The systematic review identified 12 studies investigating the relationship between surgical outcomes of orthopaedic lower extremity fractures and pre-existing mental health disorders in non-geriatric populations. Studies included patients with pelvis, femur, tibia, and ankle fractures. A majority (83%) of these studies demonstrated that patients with pre-existing mental health diagnoses had inferior functional outcomes, heightened pain levels, or an increase in postoperative complications.

Discussion

The presence of pre-existing mental health conditions, particularly anxiety and depression, may predispose orthopaedic trauma patients to an elevated risk of suboptimal functional outcomes, increased pain, or complications after surgical intervention for lower extremity fractures. Future research should focus on interventions that mitigate the impact of mental health conditions on orthopaedic outcomes and patient wellness in this population.

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Funding

The project received no financial support.

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Authors and Affiliations

  1. Duke University School of Medicine, Durham, NC, USA

    Emily M. Peairs, Tristan Chari, Sally J. Kuehn, Bruno Valan, Dana G. Rowe, Alexandra Hunter Aitchison, Alyssa Henriquez & Steph Hendren

  2. Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA

    Eoghan T. Hurley, Alexandra V. Paul, Trevor A. Lentz, Christian A. Péan & Malcolm DeBaun

  3. Duke Clinical Research Institute, Durham, NC, USA

    Trevor A. Lentz

  4. Duke Margolis Center for Health Policy, Durham, NC, USA

    Trevor A. Lentz & Christian A. Péan

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Contributions

M.D. reports the following disclosures; A.C. (stock or stock options), DePuy, A Johnson & Johnson Company (research support), Metalogix (IP royalties; Paid consultant), Next Science (Paid consultant), NSite (Stock or stock options), Reselute (IP royalties; Paid consultant; Stock or stock Options), Shukla (IP royalties; Paid consultant), SI Bone (Paid consultant), Synthes (Paid consultant), Wolters Kluwer Health—Lippincott Williams & Wilkins (Publishing royalties, financial or material support). C.P. reports the following disclosures: Arthrex, Inc (Paid presenter or speaker), Azra Care Inc. (Paid consultant; Stock or stock options), Kaizen Clinical Partners (Paid consultant).

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Correspondence to Emily M. Peairs.

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Peairs, E.M., Chari, T., Kuehn, S.J. et al. The association of pre-existing mental health conditions and patient outcomes after lower extremity orthopaedic trauma: a scoping review. Eur J Orthop Surg Traumatol 34, 1111–1120 (2024). https://doi.org/10.1007/s00590-023-03768-8

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