Psychosocial Impact of Prolonged Skeletal Traction of Lower Extremity Fractures in a Philippine Specialty Tertiary Government Hospital

Main Article Content

Gayle Krystle A. Grey, MD
Ser Anthony B. Si, MD

Abstract

Introduction. Skeletal traction for lower extremity injuries remains a preliminary treatment in managing lower extremity fractures in a Philippine tertiary orthopedic hospital. Studies have shown an increased prevalence of the development of depression and anxiety among those confined on skeletal traction before their definitive surgery.


Objective. This study associated variables present in the patient population to the development of depressive and/or anxiety symptoms while on skeletal traction before surgery for lower extremity fractures.


Methodology. Depression and anxiety symptoms were determined using the Hospital Anxiety and Depression Scale in Filipino Version (HADS-P), which is the validated Filipino language version. Clinical and social variables were gathered from patient interviews before the administration of the scoring tool. The HADS-P questionnaire was administered before skeletal traction and a day before definitive surgery.


Results. The study included fifty-four adult patients without prior psychiatric diagnoses and medications indicated for lower extremity skeletal traction before surgery. The results showed an increase in depressive and anxiety symptoms among the population. However, no significant difference was seen relative to the identified demographics. There was a minimum traction duration of 30 days and a maximum of 76 days.


Conclusion. All patients exhibited increased depressive symptoms, however, the longer the duration of traction, the more depressed they got however with less or retained anxiety symptoms. The incidence of these symptoms did not have a significant relationship to the number of days they were in traction nor with the identified patient demographics.

Article Details

How to Cite
Grey, G. K., & Si, S. A. (2023). Psychosocial Impact of Prolonged Skeletal Traction of Lower Extremity Fractures in a Philippine Specialty Tertiary Government Hospital. Philippine Journal of Orthopaedics, 38(1), 41–46. https://doi.org/10.69472/poai.2023.07
Section
Original Articles
Author Biography

Ser Anthony B. Si, MD, Philippine Orthopedic Center

Senior Consultant, Trauma , POC

Orthopedic Surgeon

References

Haug L, Wazakili M, Young S, Van den Bergh G. Longstanding pain and social strain: patients' and health care providers' experiences with fracture management by skeletal traction; a qualitative study from Malawi. Disabil Rehabil. 2017;39(17): 1714–21. https://pubmed.ncbi.nlm.nih.gov27440263 https://doi.org/10.1080/09638288.2016.1207109

Rothenhäusler HB. Psychische erkrankungen im allgemeinkrankenhaus [Mental disorders in general hospital patients]. Psychiatr Danub. 2006;18(3-4): 183–92. German. https://pubmed.ncbi.nlm.nih.gov17099609.

Perlas AP, Briones-Querijero MM, Abcede D, Buot M, Elma-Chua L, Demetrio JL, Diokno GL, Espanola HC, De La Fuente EB, Pagaduan-Lopez J, Paradela AM, Tronco AT, Sarol JN. The prevalence of psychiatric disorders among the chronically-ill medical patients in selected tertiary hospitals in the Philippines. Philipp J Psychiatry. 2004;28(1): 17–24.

Putnam N, Yager J. Traction intolerance syndrome: a psychiatric complication of femoral fractures. Int J Psychiatry Med. 1977-1978;8(2): 133–43. https://pubmed.ncbi.nlm.nih.gov631995 https://doi.org/10.2190/vlx8-nqrf-92ec-nhuw

Schwartz S, Bazargan-Hejazi S, Pan D, Ruiz D, Shirazi A, Washington E. Association of Psychiatric Diagnostic Conditions with hospital care outcomes of patients with Orthopedic Injuries. Perm J. 2018;22: 17–120. https://pubmed.ncbi.nlm.nih.gov29702056 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922806 https://doi.org/10.7812/TPP/17-120

Block AR, Ohnmeiss DD, Guyer RD, Rashbaum RF, Hochschuler SH. The use of presurgical psychological screening to predict the outcome of spine surgery. Spine J. 2001;1(4): 274–82. https://pubmed.ncbi.nlm.nih.gov14588332 https://doi.org/10.1016/s1529-9430(01)00054-7

Weinberg DS, Narayanan AS, Boden KA, Breslin MA, Vallier HA. Psychiatric illness is common among patients with orthopaedic polytrauma and is linked with poor outcomes. J Bone Joint Surg Am. 2016;98(5): 341–8. https://pubmed.ncbi.nlm.nih.gov26935455 https://doi.org/10.2106/JBJS.15.00751

de Guzman MLR. “A validation of the Hospital Anxiety and Depression Scale (HADS) in the medically-ill”. Acta Med Philipp. 2013;47(3). https://doi.org/10.47895/amp.v47i3.1318.

Aherrera JA, Abrahan LL, Racaza G, Train C, Jara DM. APSC2015-1178 depression and anxiety in adult filipinos with congenital heart disease using the validated Filipino version of the Hospital Anxiety and Depression Score (HADS). Global Heart. 2015. https://doi.org/10.1016/j.gheart.2015.03.029.

Shoar S, Naderan M, Aghajani M, Sahimi-Izadian E, Hosseini-Araghi N, Khorgami Z. Prevalence and determinants of depression and anxiety symptoms in surgical patients. Oman Med J. 2016;31(3): 176–81. https://pubmed.ncbi.nlm.nih.gov27162587 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852078 https://doi.org/10.5001/omj.2016.35

Brodke DJ, Saltzman CL, Brodke DS. PROMIS for orthopaedic outcomes measurement. J Am Acad Orthop Surg. 2016;24(11): 744–9. https://pubmed.ncbi.nlm.nih.gov27661391https://doi.org/10.5435/JAAOS-D-15-00404

Liberzon I, Abelson JL, Amdur RL, et al. Increased psychiatric morbidity after abdominal aortic surgery: risk factors for stress-related disorders. J Vasc Surg. 2006;43(5): 929–34. https://pubmed.ncbi.nlm.nih.gov16678685 https://doi.org/10.1016/j.jvs.2006.01.026

Martin RL, Christoforetti JJ, McGovern R, et al. The impact of depression on patient outcomes in hip arthroscopic surgery. Orthop J Sports Med. 2018;6(11): 2325967118806490. https://pubmed.ncbi.nlm.nih.gov/30480015 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240974 https://doi.org/10.1177/2325967118806490

Denman D, Perry J, Kauk J. Mental Health: More Than an Afterthought in Orthopaedics. American Academy of Orthopaedic Surgeons. 2022. Accessed October 15, 2023. https://www.aaos.org/aaosnow/2021/nov/development/development02/.