Manmeet Singh

Sunil G Gupte

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IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)  
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 11 Ver. VIII (Nov. 2015), PP 116-119 
www.iosrjournals.org 
DOI: 10.9790/0853-14118116119                                         www.iosrjournals.org                                 116 | Page 
 
Psychiatric Morbidity in Patients with Lower Limb Long Bone   
Fracture 
 
Manmeet Singh 
1
, Sunil G. Gupte 
2
 
1
(Psychiatry, Acharya Shri Chander College of Medical Sciences, Jammu, India) 
2
(Psychiatry, Dr. Vasantrao Pawar Medical College and Research centre, Nashik/ Maharashtra, India) 
 
Abstract:  
Objective: The aim of this study was to evaluate the psychiatric morbidity amongst patients with lower limb 
long bone fracture.  
Method: The present study was approved by the Institutional Ethics Committee of the medical college. The 
study was carried out amongst 38 randomly selected   patients in the age group of 18- 65 yrs who had sustained 
lower limb long bone fracture. Patients were evaluated 4-6 weeks after the trauma over a period of 4 months 
after their written informed consent. All findings were reported on semi-structured Proforma and cases were 
screened using MINI version 6.0 (Mini International Neuropsychiatric Interview).  
Results: 34.21% patients of lower limb long bone fracture had psychiatric morbidity study.  The most common 
diagnosis was Major depressive disorder alone or with other co morbidities, found in 31.5% cases.
 
 Anxiety 
disorders were the second most common diagnosis. Psychiatric morbidity found more in road traffic accident 
cases.  Females (50%) were more affected as compared to males. The study also shows that psychopathology 
appears to be more common in compound fracture (55.4%).   
Conclusion: Psychopathology was found more in Road traffic accidents as compared to falls .Psychopathology 
was found more in females as compared to males. Psychopathology was found more in compound fracture as 
compared to closed fracture. 
Keywords: Limb fractures, Road traffic accidents, Major depressive disorder          
                              
I. Introduction: 
 The term ‘trauma’ stems from the Greek word meaning ‘a piercing of the skin or a wound’. Limb 
fractures due to traumatic injury cause pain, prolonged discomfort, loss of function and immobility and are 
expected to produce adverse psychological effects, but have not been systematically studied.  
 Behavioural disturbances and psychiatric disorders are reported to be three to five times more frequent 
among people with injuries severe enough to require a stay in hospital. 
1
 
 Undetected psychiatric morbidity in medical and surgical wards have been estimated to vary from 20% 
to 80%, but only a small fraction of these are correctly identified and treated. 
2, 3, 4
 
  Undiagnosed psychological morbidity leads to suffering in the patient which could have been 
avoidable. In addition, maladaptive behaviour due to anxiety, depression, acute and chronic brain syndromes, 
psychosis and substance abuse may modify the clinical presentation and complicate the management of the 
underlying medical or surgical condition. 
3 -5 
 Long limb bone trauma leading to loss of a limb for whatever reason is a major event with profound 
implications for psychological health of an individual involved.  
6, 7 
 The identification and treatment of psychological disorders in these patients may not only ease 
treatment but also speed up and complete the patient's recovery process. 
 This study endeavours to explore any psychiatric morbidity in patients of traumatic lower limb long 
bone fracture. 
 
II. Material and methods: 
The present study was approved by the   Ethics Committee of Dr Vasantrao  Pawar Medical College, 
Nashik- Maharashtra. 
Present study was carried out amongst 38 randomly selected   patients from the Department of 
Orthopaedics of a tertiary health care centre in the age group of 18- 65 yrs who had sustained lower limb long 
bone fracture. Unconscious patients, patients with traumatic brain injury, mental retardation, pre existing mental 
or psychological illness excluded by history are not included in the study. Patients were evaluated 4-6 weeks 
after the trauma over a period of 4 months from AUG 2012 – NOV 2012 after their written informed consent. . 
All privacy and confidentiality safeguard were observed. 
All findings were reported on semi-structured Performa and cases were screened using MINI version 
6.0 (Mini International Neuropsychiatric Interview). 
8
 Statistical analysis was done by using SPSS (version) 16. 
Psychiatric Morbidity in Patients with Lower Limb Long Bone   Fracture  
DOI: 10.9790/0853-14118116119                                         www.iosrjournals.org                                 117 | Page 
III. Result: 
TABLE 1:  Socio-demographic Profile of the study population 
Characteristics Categories Frequency Percentage (%) 
 
Gender 
Male 26 68.42 
Female 12 31.57 
 
 
Age (years) 
Up to 20 yrs 2 5.2 
21 - 30 yrs 11 28.9 
31 - 40 yrs 09 23.6 
41-  50 yrs 4 10.5 
Above 50 yrs 12 31.5 
 
Education 
Illiterate 10 26.3 
Up to class 5 2 5.2 
 Class 6 to 10 18 47.3 
Above class 10 4 10.5 
Graduate 4 10.5 
 
Family income 
( Rs per month) 
 
Up to Rs 2000/- 6 15.7 
Rs 2001 to 4000/- 14 36.8 
Rs 4001 to 6000/- 7 18.4 
Above Rs 6000/- 11 28.9 
 
 
Marital status  
Un married 7 18.42 
Married 27 71.05 
Widowed 2 5.2 
Separated 1 2.6 
Divorced 1 2.6 
 
Religion 
Hindu  36 94.7 
Muslim  2 5.2 
Place of 
Residence 
Urban 36 94.7 
Rural 2 5.2 
 
 This table shows Demographic profile of lower limb long bone fracture patients in which majority of 
the cases were males 26 (68.42%), fall in age group of 21-40 yrs constitute (52.5%), majority of cases studied 
upto 10 th std (47.3%), 36.8% had family income of Rs 2000- 4000, 71.05 %cases were married, 94.7 % 
belongs to hindu religion & are from rural areas. 
 
TABLE 2: Distribution of Cause of fracture and Gender 
 
CAUSE OF FRACTURE 
GENDER 
 
 
MALES FEMALES Total 
ROAD TRAFFIC ACCIDENTS 20 6 26 
FALL 4 8 12 
Total 24 14 38 
 
TABLE 3: Gender wise distribution of Psychiatric morbidity and Cause of fracture 
 
CAUSE OF FRACTURE 
PSYCHIATRIC MORBIDITY 
 
 
MALES FEMALES Total 
ROAD TRAFFIC 
ACCIDENTS 
06 03 09 
FALL 01 03 04 
Total 07 06 13 
 
 Analysis of Psychiatric morbidity reveals it was found more in Road traffic accidents (n=09) 6 males, 3 
females as compared to cases of fall. 
 
TABLE 4:  Psychopathology found in study group males and females 
PSYCHIATRIC MORBIDITY MALE PATIENTS n (%) FEMALE PATIENTS n (%) TOTAL 
MDD               4 (15.38)             2 (16.66)           6 
PTSD               1 (3.84)             0           1 
MDD + PTSD               1 (3.84)             0           1 
MDD + PD current               0             2 (16.66)           2 
MDD + GAD               1  (3.84)             0           1 
MDD + PD with AG + GAD current               0             2 (16.66)           2 
Total               7  (26.92)             6  (50)          13  (34.21) 
No Psychiatric Morbidity              19 (73.07)             6 (50)          25 (65.78) 
GRAND TOTAL              26             12          38 
X2 ( with Yates Correction) = 1.306, Fisher’s exact test p = 0.226, Not significant 
 
Psychiatric Morbidity in Patients with Lower Limb Long Bone   Fracture  
DOI: 10.9790/0853-14118116119                                         www.iosrjournals.org                                 118 | Page 
 MDD: Major depressive disorder, PTSD: Post traumatic stress disorder, PD: Panic disorder, GAD- 
Generalized anxiety disorder, AG: Agoraphobia 
 In our study of 26 males and 12 females, 13 (34.21%) patients were diagnosed with psychiatric 
morbidity and it was found more in females (50%) as compared to males (26.92 %).  
 
TABLE 5:  Distribution of Psychiatric Morbidity and Type of fracture 
PSYCHIATRIC MORBIDITY CLOSED FRACTURE  
               n  (%) 
COMPOUND 
FRACTURE n (%) 
TOTAL 
MDD                    2              4           6 
PTSD                    1              0           1 
MDD + PTSD                    1              0           1 
MDD + PD current                    2              0           2 
MDD + GAD                    0              1           1 
MDD + PD with AG + GAD current                    2              0           2 
Total                    8  (27.58)             5 (55.5)         13  (34.21) 
No Psychiatric Morbidity                  21 (72.41)             4 (44.5)         25 (65.78)  
Grand Total                  29              9         38 
X2 ( with Yates Correction) = 1.306, Fisher’s exact test p = 0.226, Not significant 
 
 MDD: Major depressive disorder, PTSD: Post traumatic stress disorder, PD: Panic disorder, GAD- 
Generalized anxiety disorder, AG: Agoraphobia 
 
 Psychiatric morbidity is equally distributed among patients with closed fracture but Major depressive 
disorder appears to be more predominant in patient with compound fracture. It was also observed  that  
Psychiatric morbidity was found more in compound fracture  5 out of  9 which is (55%) as compared to closed 
fracture, 8 out of 29 which is ( 27.58%). 
 
IV. Discussion 
 There were no statistically significant differences in demographic profile of patients with and without   
psychiatric morbidity.  Majority of patients were males as they are more frequently exposed to combat, 
accidents, and physical attacks and have a higher prevalence of exposure in general.
9 
Majority of them 
 belong to Hindu community because of preponderance of Hindus in the population. Most of the patients come 
from rural area as the medical college is located in rural area. In most of our study cases fractures had occurred 
due to road traffic accidents and psychiatric morbidity found more in road traffic accident cases, this is in 
agreement with earlier studies. 
2, 3
 
 In the present study 34.21% patients of lower limb long bone fracture had psychiatric morbidity 
comparable to other study 
10
 which has psychiatric morbidity in 35% of leg fracture patients. Incidentally this 
study 
10
 was conducted on security force personnel in counter insurgency area and those personnel had 
additional stress of working in counter insurgency area. 
               In the present study the most common diagnosis was Major depressive disorder alone or with other co 
morbidities, found in 31.5% cases which is in agreement with previous western studies.
11
   Anxiety disorders 
were the second most common diagnosis found. In the present  study prevalence of Post traumatic stress 
disorder (PTSD) was 5.2% where as in other studies, the prevalence of PTSD between 1 and 6 months after 
trauma has been variously quoted as 29.9% 
12
, 23.1% 
13  
& 42 % 
14
 . 
 In the present  study prevalence of other anxiety disorder include Generalized anxiety disorder (7.9%), 
Panic disorder ( 10.5%) where as in other studies , the reported prevalence of other anxiety disorders includes 
rates for travel anxiety (28%) 
15
, panic disorder (6%), generalized anxiety disorder (4%), and simple phobia 
(4%)
16
 . 
                  In our study, females (50%) were more affected as compared to males this could be because 
depression and anxiety are more common in females 
17
. The study also shows that psychopathology appears to 
be more common in compound fracture (55.4%). Our search for references did not yield any useful information 
comparing the psychopathology found in compound and closed fracture.  However, it is speculated that 
compound fractures with more severe degree of injury, pain, swelling and requiring more time for healing may 
lead to increased incidence of psychopathology. 
                  There could be bidirectional relationship between long bone trauma and psychopathology which 
needs to be carefully evaluated
18, 19
. 
 
V. Limitation: 
 The most important limitation of our study was Small Sample size. The trends needs to be further 
carefully evaluated in patients with larger sample size. Causality of associations cannot be confirmed because 
Psychiatric Morbidity in Patients with Lower Limb Long Bone   Fracture  
DOI: 10.9790/0853-14118116119                                         www.iosrjournals.org                                 119 | Page 
relationship between psychiatric morbidity and traumatic lower limb long bone fracture against other socio-
demographic factors were not evaluated 
 
VI. Conclusion: 
Our study revealed the following trends:  
 Psychopathology was found more in Road traffic accidents as compared to falls .Psychopathology was 
found more in females as compared to males. Psychopathology was found more in compound fracture as 
compared to closed fracture. 
 
VII. Recommendation 
 Psychopathology was found more in Road traffic accidents as compared to falls. Preventive measures 
aimed at improving mechanical transport discipline could bring down psychiatric morbidity associated with 
Road traffic accidents. 
 In view of the possibility of increased psychiatric morbidity among patients with lower limb long bone 
trauma, psychiatric assessment and management will enhance the patient care.  
 
References 
[1]. Malt U Fo Psychiatric aspects of accidents, burns and other    trauma. In :  Gelder MG, Lopez-Ibor  JJ Andreasen N. Editors. New 
Oxford Textbook of Psychiatry. Oxford. Oxford University Press 2000;1185-93. 
[2]. Gobar  AH, Collins JL, Mathura CB. Utilisation of a consultation-liaison psychiatry service in a general hospital. Journal of the 
National Medical Association 1987;79:505-8. 
[3]. Kuhn WF, Bell RA, Netscher RE, Seligman D, Kuki SO. Psychiatric assessment of leg fracture patients: A pilot study. International 
Journal of Psychiatry in Medicine 1989; 19:145-54. 
[4]. Clark DA, Cook A, Snow D. Depressive symptom differences in hospitalised medically ill, depressed psychiatric inpatients and 
nonmedical controls. J Abnormal Psychol 1998; 107:38-48.  
[5]. Elvy GA, Gillespie WJ. Problem drinking in onhopaedic patients. J Bone Joint Surg 1985;67B:478-81. 
[6]. shukla GD, Sahu c , Tripathi RP , Gupta d. Phantom limbs: a phenomenological study. Br j psychiatry 1982;141:54-58 
[7]. Kashani JH, Frank RG, Kashni SR, et al . Depression among amputees.  J clin Psychiatry 1983; 44: 256-258. 
[8]. Sheehan D, Janavs J, Baker R, Sheehan KH, Sheehan M. Mini international neuropsychiatric interview (M.I.N.I.) English Version 
6.0.0. South Florida; 2009. Available from http://www.nccpsychiatry.info/File/ MINI.600.pdf.  
[9]. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB: Posttraumatic stress disorder in the National Comorbidity Survey. Arch 
Gen Psychiatry1995; 52:1048–1060.  
[10]. S. chaudhary ,  TR John &  A.K. sharma . Psychiatric evaluation of limb fracture patients: MJAFI  2002;58: 107-110. 
[11]. O'Donnell ML, Creamer M, Pattison P, Atkin C: Psychiatric morbidity following  injury. Am J Psychiatry 2004; 161:507–514. 
[12]. Shalev AY, Freedman S, Peri T, Brandes D, Sahar T, Orr SP, Pitman RK: Prospective study of posttraumatic stress disorder and 
depression following trauma. Am J Psychiatry 1998; 155: 630–63 
[13]. Ehlers A, Mayou RA, Bryant B: Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. J 
Abnorm Psychol 1998; 107:508–519 
[14]. Michaels AJ, Michaels CE, Moon CH, Smith JS, Zimmerman MA, Taheri PA, Peterson C: Posttraumatic stress disorder after 
injury: impact on general health outcome and early risk assessment. J Trauma 1999; 47:460–466 
[15]. Mellman TA, David D, Bustamante V, Fins AI, Esposito K: Predictors of post-traumatic stress disorder following severe injury. 
Depress Anxiety 2001; 14:226–231 
[16]. Mayou R, Bryant B: Outcome in consecutive emergency department attenders following a road traffic accident. Br J Psychiatry 
2001; 179:528–534  
[17]. Zoltan Rihmer, Jules Angst . Mood disorders : Epidemiology.  Sadock  V A, Ruiz, editors. Kaplan & sadock`s Comprehensive text 
book of psychiatry, 9 th edition lippincott williams and wilkins; 2009; 1645-1653. 
[18]. Frank,L.(1963). Self preservation and the development of accident proness in children . Psychoanal.st.,18:464-483 
[19]. Ozer k, Gillani S , Williams A, Hak DJ; J Pediatr Orthop. 2010 Jun;30(4):324-7.Psychiatric risk factors in pediatric hand fractures 
 


Psychiatric Morbidity in Patients with Lower Limb Long Bone Fracture

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Psychiatric Morbidity in Patients with Lower Limb Long Bone Fracture

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