Herge Whitney M, Samchukov Mikhail, Elerson Emily, Cherkashin Alexander, Podeszwa David
Scottish Rite for Children, Dallas, TX, USA.
J Pediatr Soc North Am. 2025 Mar 25;11:100185. doi: 10.1016/j.jposna.2025.100185. eCollection 2025 May.
A 12+9-year-old female-assigned at birth diagnosed with osteofibrous dysplasia of her right tibia underwent 15cm bone resection, ipsilateral pedicled fibular graft, and frame application without a thorough multidisciplinary preoperative evaluation. During her course of treatment, the patient's mood and ability to participate in her own care (e.g. showering, feeding herself on a regular and consistent basis, completing home exercises) declined precipitously, and she began to endorse symptoms of suicidal ideation and non-suicidal self-injury behavior. Eventually the patient had to be admitted to the team's pediatric orthopaedic institution and was later transferred to an intensive outpatient mental health program for safety and mood stabilization. Due to multiple absences, the patient was prematurely dismissed from the mental health program and subsequently refused to participate with any sort of mental health intervention. Simultaneously, she struggled to cope with the demands of her external fixation treatment.Broadly, this case highlights the critical importance of thorough psychological assessment prior to consideration of limb lengthening and/or reconstruction. Psychological assessment should first establish the patient's baseline mental health, identify any extant mental health symptoms, and connect the patient with appropriate intervention as needed. Second, psychological assessment should establish the family's baseline functioning, including caregiver availability and support as well as emotional and logistical resources available to support treatment. Third, psychological assessment should continue throughout the course of treatment, in order to identify real time possible changes in a patient's mental health and intervention needs.
(1)Inadequate preoperative assessment of a patient and family being considered for limb lengthening and/or reconstruction may result in significant medical and psychological consequences for the patient during and after treatment.(2)Preoperative psychological assessment should establish a patient's baseline mental health and identify any pre-existing mental health concerns.(3)Preoperative psychological assessment should establish a family's baseline functioning, focusing on the cognitive, emotional, and logistical resources available to support treatment demands.(4)Psychological assessment should continue throughout treatment, in order to promptly identify any emotional concerns that arise throughout treatment.
一名出生时被指定为女性、年龄为12岁9个月的患者，被诊断出患有右胫骨骨纤维发育不良，在未进行全面的多学科术前评估的情况下，接受了15厘米的骨切除、同侧带蒂腓骨移植和外固定架应用。在治疗过程中，患者的情绪以及参与自我护理的能力（如洗澡、定期且持续地自行进食、完成家庭锻炼）急剧下降，并且开始出现自杀意念和非自杀性自伤行为的症状。最终，患者不得不入住该团队所在的儿科骨科机构，随后为了安全和稳定情绪被转至强化门诊心理健康项目。由于多次缺席，患者被过早地从心理健康项目中除名，随后拒绝参与任何形式的心理健康干预。同时，她难以应对外固定治疗的要求。总体而言，该病例凸显了在考虑肢体延长和/或重建之前进行全面心理评估的至关重要性。心理评估首先应确定患者的心理健康基线，识别任何现存的心理健康症状，并根据需要为患者提供适当的干预。其次，心理评估应确定家庭的功能基线，包括照顾者的可及性和支持，以及可用于支持治疗的情感和后勤资源。第三，心理评估应在整个治疗过程中持续进行，以便识别患者心理健康和干预需求的实时可能变化。
（1）对考虑进行肢体延长和/或重建的患者及其家庭进行术前评估不足，可能会在治疗期间和治疗后给患者带来重大的医学和心理后果。（2）术前心理评估应确定患者的心理健康基线，并识别任何预先存在的心理健康问题。（3）术前心理评估应确定家庭的功能基线，重点关注可用于支持治疗需求的认知、情感和后勤资源。（4）心理评估应在整个治疗过程中持续进行，以便及时识别治疗过程中出现的任何情感问题。
