{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T13:35:30Z","timestamp":1786714530970,"version":"build-2736575974"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","funder":[{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"crossref","award":["W81XWH-09-1-0108"],"award-info":[{"award-number":["W81XWH-09-1-0108"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n To report the prevalence of adverse mental health outcomes 1 year after severe open tibial shaft fractures and their association with treatment and complication risk factors.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n .<\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Randomized controlled trial.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Multicenter.<\/jats:p>\n <\/jats:sec>\n \n Patient Selection Criteria:<\/jats:title>\n Eligible patients were 18\u201364 years of age with severe open tibial shaft fractures (AO\/OTA 41\u201343) treated with modern external ring fixation or internal fixation. All Gustilo\u2013Anderson type IIIB fractures were included and some type IIIA meeting specific severity criteria.<\/jats:p>\n <\/jats:sec>\n \n Outcome Measures and Comparisons:<\/jats:title>\n Outcome measures included Patient Health Questionnaire scores for depression symptoms, posttraumatic stress disorder (PTSD) Checklist for DSM-IV (PCL-S), and the Brief Pain Inventory. Primary comparisons assessed depression, PTSD, and pain between treatment groups (modern external ring fixation vs. internal fixation).<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n A total of 254 patients were treated with external ring fixation (n = 121) or internal fixation (n = 133). The mean age was 39 years (SD = 13) and 16% were female. At 12 months after injury, 34% of patients had Patient Health Questionnaire-9 scores consistent with moderate to severe depression. Risk factors for depression were female sex (RR: 1.70 [1.01\u20132.86]), high school educational attainment or less (RR: 1.93 [1.27\u20133.04]), and any baseline mental health condition (RR: 1.91 [1.22\u20132.99]), all\n P<\/jats:italic>\n < 0.05. At 12 months, 45% of patients met criteria for PTSD. Any baseline mental health condition was a risk factor for developing PTSD (RR: 2.07 [1.50\u20132.88]),\n P<\/jats:italic>\n < 0.001. Protective factors against the development of depression and PTSD included higher self-efficacy at 6 weeks after injury and any major limb complication (eg, infection) within 12 months, both\n P<\/jats:italic>\n < 0.01. Moderate to severe daily pain interference was reported by 49% of participants at 12 months and was associated with high school\u2013level education attainment or less (RR: 1.41 [1.03\u20131.94]) and was mitigated by self-efficacy at 6 weeks postinjury (RR: 0.53 [0.38\u20130.74]), both\n P<\/jats:italic>\n < 0.05. Fixation modality (external ring fixation vs. internal fixation) was not associated with depression (RR: 0.82 [0.83\u20131.27],\n P<\/jats:italic>\n = 0.37), PTSD (RR: 1.06 [0.77\u20131.48],\n P<\/jats:italic>\n = 0.71), pain intensity (RR: 0.98 [0.63\u20131.51],\n P<\/jats:italic>\n = 0.92), or pain interference (0.96 [0.70\u20131.33],\n P<\/jats:italic>\n = 0.83).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Mental health sequelae and moderate to severe pain were common 1 year after sustaining a severe open tibial shaft fracture. Adverse mental health outcomes and pain were not influenced by fixation modality (external ring fixation vs. internal fixation).<\/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.0000000000003203","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T13:02:00Z","timestamp":1777381320000},"page":"466-472","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Adverse Mental Health Outcomes After Modern External Ring Fixation Versus Internal Fixation for Severe Open Tibia Fractures: A Secondary Analysis of the FIXIT Study"],"prefix":"10.1097","volume":"40","author":[{"given":"Natasha M.","family":"Simske","sequence":"first","affiliation":[{"name":"Texas Tech University Health Sciences Center El Paso, El Paso, TX;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin K.","family":"Solarczyk","sequence":"additional","affiliation":[{"name":"University of California, San Francisco, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin R.","family":"Thompson","sequence":"additional","affiliation":[{"name":"University of California, San Francisco, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Reider","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert V.","family":"O'Toole","sequence":"additional","affiliation":[{"name":"University of Maryland School of Medicine, Baltimore, MD;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eben A.","family":"Carroll","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine, Winston-Salem, NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhav A.","family":"Karunakar","sequence":"additional","affiliation":[{"name":"Atrium Health-Carolinas Medical Center, Charlotte, NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Obremskey","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Nashville, TN;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen M.","family":"Quinnan","sequence":"additional","affiliation":[{"name":"St. Mary's Medical Center, West Palm Beach, FL;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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