Tan Gerald, Laubscher Maritz, Maqungo Sithombo, Truss Adam, Berry Kirsty, Ferreira Nando, Graham Simon Matthew
Mersey Orthopaedic Trainee Association, Liverpool, United Kingdom.
Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
JB JS Open Access. 2025 Apr 25;10(2). doi: 10.2106/JBJS.OA.24.00124. eCollection 2025 Apr-Jun.
Fractures occur at disproportionately higher rates in low-income and middle-income countries (LMIC) and commonly occur following a traumatic event. The association between suffering from a fracture and the development of psychological symptoms is under-reported. The aim of this study was to investigate the prevalence and risk factors of developing post-traumatic stress disorder (PTSD) among patients following lower limb trauma in South Africa.
The study was undertaken from September 2017 to December 2018 and included a cohort of 260 patients with lower limb long bone fractures. Patients were screened using the Primary Care PTSD (PC-PTSD-5) screening tool, which is a gold standard measure to identify patients at risk of PTSD in the civilian population. Within this cohort, high-risk patients were assessed with the PTSD checklist (PCL-C), which is a standardized questionnaire scale to indicate if an individual may have PTSD.
There were 254 patients in the final cohort analysis with ages ranging from 18 to 71 years, and 75.6% (192/254) of the cohort were male patients. Femoral fractures were found in 51.6% (131/254) of patients while tibial fractures were found in 48.4% (123/254). The rate of PTSD within the study population was found to be 7.1% (18/254), and the risk of developing PTSD was 13.4% (34/254). We did not identify any risk factors, including open fractures, high-injury severity, and complication such as nonunion, for the development of PTSD.
This study found the rate of PTSD to be lower compared with that in high-income countries, but still higher than the general population in South Africa. Our study indicates that screening for PTSD in patients with lower limb trauma in LMICs could be beneficial. Early identification of patients at risk of developing PTSD would enable appropriate resources, support, and treatment to be provided.
Level II. See Instructions for Authors for a complete description of levels of evidence.
在低收入和中等收入国家（LMIC），骨折发生率高得不成比例，且通常发生在创伤事件之后。骨折与心理症状发展之间的关联报道不足。本研究的目的是调查南非下肢创伤患者中创伤后应激障碍（PTSD）的患病率及危险因素。
本研究于2017年9月至2018年12月进行，纳入了260例下肢长骨骨折患者队列。使用初级保健PTSD（PC-PTSD-5）筛查工具对患者进行筛查，该工具是识别平民人群中PTSD风险患者的金标准措施。在该队列中，对高危患者使用PTSD检查表（PCL-C）进行评估，这是一种标准化问卷量表，用于表明个体是否可能患有PTSD。
最终队列分析中有254例患者，年龄在18至71岁之间，队列中75.6%（192/254）为男性患者。51.6%（131/254）的患者为股骨骨折，48.4%（123/254）的患者为胫骨骨折。研究人群中PTSD发生率为7.1%（18/254），发生PTSD的风险为13.4%（34/254）。我们未发现任何导致PTSD发生的危险因素，包括开放性骨折、高损伤严重程度以及诸如骨不连等并发症。
本研究发现PTSD发生率低于高收入国家，但仍高于南非普通人群。我们的研究表明，在低收入和中等收入国家对下肢创伤患者进行PTSD筛查可能有益。早期识别有发生PTSD风险的患者将有助于提供适当的资源、支持和治疗。
二级。有关证据水平的完整描述，请参阅作者指南。
