Summary

Orthopaedic trauma can lead to mental health concerns including depression, anxiety, and fear of movement, and hamper readiness for return to sport among patients aged 18 or under; to date, no studies have assessed the effectiveness of early psychological interventions to mitigate these impacts.

Abstract

Purpose

Orthopaedic trauma patients often experience elevated distress post-injury, which can increase the risk of developing mental health concerns like depression, anxiety, and post-traumatic stress disorder (PTSD). Most literature focuses on the adult population; in this review, we aimed to assess the psychological impacts (PIs) of orthopaedic injuries (OIs) on patients aged 18 or under (paediatric patients).

Methodology

The EMBASE, MEDLINE, Web of Science, CINAHL, and PsycInfo databases were searched using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) frameworks. Original, peer-reviewed, English-language articles published between 2000 and July 2022 were screened by two reviewers using Covidence. Studies that characterized PIs of OIs on paediatric patients were included. Studies unrelated to PIs, with participants aged > 18 only, without OIs, or with chronic conditions like arthritis were excluded. Screening discrepancies were resolved by discussion. Cohen’s kappa was > 0.7 across reviewers and stages.

First author, year of publication, country, study aim and design, sample size, patient demographics, and inclusion and exclusion criteria were extracted from included studies. Injury-related data including time since injury, injury type (e.g., fractures, sprains, or ACL tears), and mechanism (e.g., MVC, sports injuries, accidental, or casualties of war) were captured. PIs including outcomes (e.g., depression, anxiety, PTSD, and kinesiophobia) and methodology (e.g., psychometric instruments, interviews, clinical assessment) were recorded. Main results, potential uses for results, and limitations were documented. Methodological Index for Non-Randomised Studies (MINORS) and Risk of Bias (RoB) 2.0 were used for quality assessment.

Results

Out of the 5438 papers found in the original search, 23 were included for analysis, of which 61% were conducted in the United States. Mechanisms of injury included sports injuries (57%), motor-vehicle accidents (26%), and accidental traumas (26%). Types of injuries included isolated ACL tears (30%), isolated fractures (26%), and fractures in addition to other injuries like sprains, ACL tears, or traumatic brain injury (26%). Pre-existing psychometric instruments including Tampa Scale of Kinesiophobia 11, Short-Form 36, and State-Trait Anxiety Inventory were used in 78% of studies. Lastly, 65% of studies explicitly recommended increasing screening or early intervention for PIs following traumatic injury.

Studies on sports injuries primarily assessed kinesiophobia and readiness for return to sport. Psychological barriers that were identified included fear of reinjury, loss of identity, and social isolation. Protective factors included strong rapport with one’s care team and general perception of social support. Two studies found significant associations between sports injuries and reduced quality of life.

Conclusions

Paediatric patients experience myriad psychological consequences beyond the physical impacts of OIs. Among patients with sports injuries specifically, this suggests that physical recovery alone is not synonymous with readiness for return to sport. We did not identify any studies that assessed the clinical utility of involving psychological supports to minimize the footprint of trauma on paediatric mental health. Future work should investigate this intervention and the best options for improving the mental health of orthopaedic patients, in different countries, cultures, and models of healthcare delivery.