{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T03:55:55Z","timestamp":1791431755819,"version":"4.3.3"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,10]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n To evaluate the risk of developing a new mental disorder diagnosis within 2 years of lower extremity fracture.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n National insurance claims database.<\/jats:p>\n <\/jats:sec>\n \n Patient Selection Criteria:<\/jats:title>\n Patients between 18 and 65 years with lower extremity, pelvis, and acetabular fractures without prior mental disorders as defined using International Classification of Diseases, 9th and 10th revision diagnosis codes were included. Mental disorders evaluated included alcohol use disorder, generalized anxiety disorder, bipolar disorder, major depressive disorder, drug use disorder, panic disorder, posttraumatic stress disorder, and suicide attempt.<\/jats:p>\n <\/jats:sec>\n \n Outcome Measures and Comparisons:<\/jats:title>\n The individual lower extremity fracture cohorts were matched 1:4 with nonfracture controls. The specific groups of interest were pelvis fractures, acetabulum fractures, proximal femur fractures, femoral shaft fractures, distal femur fractures, patella fractures, tibia plateau fractures, tibia shaft fractures, ankle fractures, pilon fractures, calcaneus fractures, and Lisfranc fractures. Rates of mental disorders after primary lower extremity fractures within 2 years were compared using multivariable logistic regression.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n Overall, the 263,988 patient-fracture group was 57.2% female with an average age of 46.6 years. Compared with controls with no fracture, patients who sustained pelvis, acetabulum, proximal femur, femoral shaft, distal femur, patella, tibia plateau, tibia shaft, pilon, calcaneus, or Lisfranc fracture had a statistically significantly increased risk of being diagnosed with a queried mental disorder within 2 years of fracture. When comparing all fracture patients by location, those suffering from fractures proximal to the knee joint, including pelvis fractures [OR: 1.51, 95% confidence interval (CI): 1.39\u20131.64] and proximal femur fractures [odds ratio (OR): 1.36, 95% CI: 1.26\u20131.47], demonstrated greater risk of developing any of the queried mental disorders compared with fractures distal to the knee, including ankle fractures (OR: 0.99, 95% CI: 0.95\u20131.03) and pilon fractures (OR: 1.05, 95% CI: 0.81\u20131.36). When comparing specific fracture patients with patients without fracture by mental disorder, patients demonstrated an increased risk of suicide attempt following fracture of the pelvis, acetabulum, femoral shaft, distal femur, and calcaneus, as well as patients sustaining a Lisfranc fracture.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n There is an increased risk of being diagnosed with a new mental disorder following lower extremity trauma in patients without prior mental disorder diagnosis compared with matched individuals without a lower extremity fracture. Among the fractures studied, those that were more proximal, such as pelvis and proximal femur fractures, carried greater risk compared with more distal fracture sites, including ankle and pilon fractures. Patients who experienced certain lower extremity fractures had a significantly higher rate of suicide attempt compared with patients without fracture. Physicians should consider increased mental health screening and potential referral for mental health evaluation for patients following lower extremity trauma.<\/jats:p>\n <\/jats:sec>\n \n LEVEL OF EVIDENCE:<\/jats:title>\n Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bot.0000000000002874","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T15:00:34Z","timestamp":1722006034000},"page":"547-556","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Lower Extremity Trauma is Associated With an Increased Rate of New Mental Disorder Diagnosis and Suicide Attempt"],"prefix":"10.1097","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1591-0011","authenticated-orcid":false,"given":"Julianna E.","family":"Winter","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob S.","family":"Budin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3373-7962","authenticated-orcid":false,"given":"Bela P.","family":"Delvadia","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4097-5668","authenticated-orcid":false,"given":"William F.","family":"Sherman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Chandra","family":"Vemulapalli","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia C.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250614","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1089\/wound.2016.0714","article-title":"Impact of traumatic lower extremity injuries beyond acute care: movement-based considerations for resultant longer term secondary health conditions","volume":"6","author":"Butowicz","year":"2017","journal-title":"Adv Wound Care (New Rochelle)"},{"key":"R2-20250614","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1097\/OI9.0000000000000139","article-title":"Determinants of functional outcome following ankle fracture","volume":"4","author":"Audet","year":"2021","journal-title":"OTA Int."},{"key":"R3-20250614","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.2106\/JBJS.H.01475","article-title":"Long-term functional outcomes after operative treatment for intra-articular fractures of the calcaneus","volume":"91","author":"Potter","year":"2009","journal-title":"J Bone Joint Surg Am"},{"key":"R4-20250614","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.jot.2018.08.002","article-title":"Functional outcomes and quality of life in adult ipsilateral femur and tibia fractures","volume":"16","author":"Demirtas","year":"2019","journal-title":"J Orthop Translat"},{"key":"R5-20250614","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1097\/BOT.0b013e318228c1a1","article-title":"Functional outcomes after operatively treated patella fractures","volume":"26","author":"LeBrun","year":"2012","journal-title":"J Orthop Trauma"},{"key":"R6-20250614","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/j.jcot.2020.08.011","article-title":"Factors affecting quality of life after pelvic fracture","volume":"11","author":"Verma","year":"2020","journal-title":"J Clin Orthop Trauma"},{"key":"R7-20250614","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1097\/BOT.0000000000000736","article-title":"Debilitating effects of femoral nonunion on health-related quality of life","volume":"31","author":"Brinker","year":"2017","journal-title":"J Orthop Trauma"},{"key":"R8-20250614","doi-asserted-by":"crossref","first-page":"2625","DOI":"10.1016\/j.acra.2023.01.041","article-title":"The impact of injury of the tibial nutrient artery canal on type of nonunion of tibial shaft fractures: a retrospective computed tomography study","volume":"30","author":"Liang","year":"2023","journal-title":"Acad Radiol."},{"key":"R9-20250614","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1186\/s12891-023-06977-8","article-title":"Early versus late surgical treatment of pelvic and acetabular fractures a five-year follow-up of 419 patients","volume":"24","author":"Enocson","year":"2023","journal-title":"BMC Musculoskelet Disord."},{"key":"R10-20250614","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1186\/s12891-023-06764-5","article-title":"Incidence and risk factors of isolated calf muscular venous thrombosis after tibial plateau fractures surgery","volume":"24","author":"Peng","year":"2023","journal-title":"BMC Musculoskelet Disord."},{"key":"R11-20250614","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1097\/SAP.0000000000003696","article-title":"Immediate soft tissue reconstruction in lower limb traumas using propeller perforator flaps","volume":"91","author":"Gatto","year":"2023","journal-title":"Ann Plast Surg."},{"key":"R12-20250614","doi-asserted-by":"crossref","first-page":"436","DOI":"10.5435\/00124635-200511000-00003","article-title":"Acute compartment syndrome in lower extremity musculoskeletal trauma","volume":"13","author":"Olson","year":"2005","journal-title":"J Am Acad Orthop Surg."},{"key":"R13-20250614","first-page":"623","article-title":"Psychiatric disorders are associated with an increased risk of injuries: data from the Iranian mental health survey (IranMHS)","volume":"45","author":"Shadloo","year":"2016","journal-title":"Iran J Public Health"},{"key":"R14-20250614","doi-asserted-by":"crossref","first-page":"341","DOI":"10.2106\/JBJS.15.00751","article-title":"Psychiatric illness is common among patients with orthopaedic polytrauma and is linked with poor outcomes","volume":"98","author":"Weinberg","year":"2016","journal-title":"J Bone Joint Surg Am"},{"key":"R15-20250614","first-page":"15","article-title":"Psychological distress and quality of life after orthopedic trauma: an observational study","volume":"51","author":"Bhandari","year":"2008","journal-title":"Can J Surg."},{"key":"R16-20250614","doi-asserted-by":"crossref","first-page":"e322","DOI":"10.5435\/JAAOS-D-20-00637","article-title":"The psychological effects of musculoskeletal trauma","volume":"29","author":"Kang","year":"2021","journal-title":"J Am Acad Orthop Surg."},{"key":"R17-20250614","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/0010-440X(76)90042-0","article-title":"Psychiatric disorders and the need for mental health services among a sample of orthopedic inpatients","volume":"17","author":"Kuyler","year":"1976","journal-title":"Compr Psychiatry"},{"key":"R18-20250614","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.2106\/JBJS.15.01261","article-title":"Psychological Distress and Orthopaedic Trauma: Commentary on an article by Douglas S. Weinberg, MD, et al.: \u201cPsychiatric Illness Is Common Among Patients with Orthopaedic Polytrauma and Is Linked with Poor Outcomes\u201d","volume":"98","author":"McQueen","year":"2016","journal-title":"J Bone Joint Surg Am"},{"key":"R19-20250614","first-page":"100","article-title":"Perioperative management of open fractures in the lower limb","volume":"32","author":"Loh","year":"2022","journal-title":"J Perioper Pract."},{"key":"R20-20250614","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.medcli.2020.12.041","article-title":"Predictive validity of the functional capacity of the CUPAX questionnaire in older adults with hip fracture","volume":"158","author":"Crespo-Fresno","year":"2022","journal-title":"Med Clin Barc"},{"key":"R21-20250614","first-page":"138","article-title":"Calcaneal fractures: radiological and CT evaluation and classification systems","volume":"89","author":"Galluzzo","year":"2018","journal-title":"Acta Biomed."},{"issue":"suppl 3","key":"R22-20250614","doi-asserted-by":"crossref","first-page":"S77","DOI":"10.1016\/j.injury.2018.09.044","article-title":"Treatment of pathologic fractures of the proximal femur","volume":"49","author":"Angelini","year":"2018","journal-title":"Injury"},{"key":"R23-20250614","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.ssmph.2017.12.005","article-title":"The relationship between physical functional limitations, and psychological distress: considering a possible mediating role of pain, social support and sense of mastery","volume":"4","author":"Backe","year":"2018","journal-title":"SSM Popul Health"},{"key":"R24-20250614","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1097\/NNR.0000000000000407","article-title":"Transition from acute to chronic pain in lower extremity fracture patients: a pain phenotyping protocol","volume":"69","author":"Griffioen","year":"2020","journal-title":"Nurs Res."},{"key":"R25-20250614","doi-asserted-by":"crossref","first-page":"4149","DOI":"10.1007\/s00402-022-04717-6","article-title":"Long-term analysis of chronic pain associated with lower extremity injuries","volume":"143","author":"Rauer","year":"2023","journal-title":"Arch Orthop Trauma Surg."},{"key":"R26-20250614","doi-asserted-by":"crossref","first-page":"e1162","DOI":"10.1097\/SLA.0000000000003780","article-title":"Mental health burden after injury: it's about more than just posttraumatic stress disorder","volume":"274","author":"Herrera-Escobar","year":"2021","journal-title":"Ann Surg."},{"key":"R27-20250614","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1007\/s00590-021-03029-6","article-title":"Outpatient lower extremity fracture surgery: should we be concerned?","volume":"32","author":"Shields","year":"2022","journal-title":"Eur J Orthop Surg Traumatol."},{"key":"R28-20250614","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s13017-018-0178-1","article-title":"Differentiation in an inclusive trauma system: allocation of lower extremity fractures","volume":"13","author":"W\u00fcrdemann","year":"2018","journal-title":"World J Emerg Surg."},{"key":"R29-20250614","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1136\/ip.2010.030080","article-title":"Youth suicide: an insight into previous hospitalisation for injury and sociodemographic conditions from a nationwide cohort study","volume":"17","author":"Zambon","year":"2011","journal-title":"Inj Prev."},{"key":"R30-20250614","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1111\/sltb.12085","article-title":"Correlates of suicidal ideation in physically injured trauma survivors","volume":"44","author":"O'Connor","year":"2014","journal-title":"Suicide Life Threat Behav."},{"key":"R31-20250614","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1097\/01.ta.0000196763.14289.4e","article-title":"Longitudinal study of suicide after traumatic injury","volume":"61","author":"Ryb","year":"2006","journal-title":"J Trauma"},{"key":"R32-20250614","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1001\/archsurg.1995.01430080046006","article-title":"High-risk behavior and the public burden for funding the costs of acute injury","volume":"130","author":"Mackersie","year":"1995","journal-title":"Arch Surg."},{"key":"R33-20250614","first-page":"833","article-title":"Relationship of high risk behaviors and negative life events with mental health of female students in high schools","volume":"45","author":"Nouruzi","year":"2016","journal-title":"Iran J Public Health"},{"key":"R34-20250614","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1038\/npp.2013.218","article-title":"Impulsivity and risk taking in bipolar disorder and schizophrenia","volume":"39","author":"Reddy","year":"2014","journal-title":"Neuropsychopharmacology"},{"key":"R35-20250614","doi-asserted-by":"crossref","first-page":"8695916","DOI":"10.1155\/2022\/8695916","article-title":"Bone fracture patterns and distributions according to trauma energy","volume":"2022","author":"Almigdad","year":"2022","journal-title":"Adv Orthop."},{"key":"R36-20250614","doi-asserted-by":"crossref","first-page":"2151459320939546","DOI":"10.1177\/2151459320939546","article-title":"High- versus low-energy acetabular fracture outcomes in the geriatric population","volume":"11","author":"Cecil","year":"2020","journal-title":"Geriatr Orthop Surg Rehabil."},{"key":"R37-20250614","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/j.injury.2020.02.038","article-title":"Psychological morbidity and functional impairment following traumatic pelvic injury","volume":"51","author":"McMinn","year":"2020","journal-title":"Injury"},{"key":"R38-20250614","doi-asserted-by":"crossref","first-page":"331","DOI":"10.5498\/wjp.v13.i6.331","article-title":"Psychological trauma, posttraumatic stress disorder and trauma-related depression: a mini-review","volume":"13","author":"Wang","year":"2023","journal-title":"World J Psychiatry"},{"key":"R39-20250614","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1056\/NEJMra035354","article-title":"Bipolar disorder","volume":"351","author":"Belmaker","year":"2004","journal-title":"N Engl J Med."},{"key":"R40-20250614","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/7854_2020_153","article-title":"The role of genetics in bipolar disorder","volume":"48","author":"Fabbri","year":"2021","journal-title":"Curr Top Behav Neurosci."},{"key":"R41-20250614","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1176\/appi.ajp.161.8.1390","article-title":"Posttraumatic stress disorder and depression following trauma: understanding comorbidity","volume":"161","author":"O'Donnell","year":"2004","journal-title":"Am J Psychiatry"},{"key":"R42-20250614","first-page":"56","volume":"156","author":"Raboch","year":"2017","journal-title":"Cas Lek Cesk"},{"key":"R43-20250614","first-page":"239","article-title":"Primary prevention in psychiatry\u2014adult populations","volume":"22","author":"Brenner","year":"2010","journal-title":"Ann Clin Psychiatry"},{"key":"R44-20250614","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.euroneuro.2022.09.008","article-title":"Primary prevention in psychiatry is not science fiction","volume":"65","author":"Arango","year":"2022","journal-title":"Eur Neuropsychopharmacol."},{"key":"R45-20250614","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/S2215-0366(18)30057-9","article-title":"Preventive strategies for mental health","volume":"5","author":"Arango","year":"2018","journal-title":"Lancet Psychiatry"},{"issue":"suppl l","key":"R46-20250614","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1016\/j.ypmed.2014.10.015","article-title":"Primary prevention of anxiety disorders in primary care: a systematic review","volume":"76","author":"Garc\u00eda-Campayo","year":"2015","journal-title":"Prev Med."},{"key":"R47-20250614","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1097\/BOT.0000000000002433","article-title":"Concurrent mental illness and financial barriers to mental health care among a nationally representative sample of orthopaedic trauma survivors","volume":"36","author":"Jella","year":"2022","journal-title":"J Orthop Trauma"},{"key":"R48-20250614","doi-asserted-by":"crossref","first-page":"2146","DOI":"10.1177\/1049732320924625","article-title":"Use of the patient health questionnaire (PHQ-9) in practice: interactions between patients and physicians","volume":"30","author":"Ford","year":"2020","journal-title":"Qual Health Res."},{"key":"R50-20250614","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1001\/jamapsychiatry.2018.3658","article-title":"Exploring comorbidity within mental disorders among a Danish national population","volume":"76","author":"Plana-Ripoll","year":"2019","journal-title":"JAMA Psychiatry"},{"key":"R51-20250614","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/7854_2020_158","article-title":"Why are suicide rates increasing in the United States? Towards a multilevel reimagination of suicide prevention","volume":"46","author":"Martinez-Ales","year":"2020","journal-title":"Curr Top Behav Neurosci."}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000002874","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,14]],"date-time":"2025-06-14T18:00:51Z","timestamp":1749924051000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000002874"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10]]},"references-count":50,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000002874","relation":{},"ISSN":["0890-5339"],"issn-type":[{"value":"0890-5339","type":"print"}],"subject":[],"published":{"date-parts":[[2024,10]]},"assertion":[{"value":"2024-04-02","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-15","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}