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The Incidence of Psychologic Stress Following a Fall and Surgical Treatment of Distal Radius Fractures
Lili Schindelar, MD, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, Brian M Katt, MD, Rothman Orthopaedic Institute, Philadelphia, PA, Clay Townsend, MD, Rothman Institute at Thomas Jefferson University Hopsital, Philadelphia, PA, Casey Imbergamo, MD, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, Robert Takei, MD, Rothman Institute, philadelphia, PA and Pedro K Beredjiklian, M.D., Rothman Institute, Philadelphia, PA

Introduction
Experiencing a fall and a subsequent distal radius fracture can have a major impact not only on patients' physical function, but also on their emotional state. The purpose of this project was to describe the prevalence of Fear of Falling (FoF) and Post Traumatic Stress Disorder (PTSD) following surgically managed distal radius fractures due to a fall.

Materials and Methods
After Institutional Review Board approval, patients who underwent surgery for a distal radius fracture due to a fall were identified by a database query. Patients were divided into three groups based on time from surgery: 0-2 weeks (Acute), 3-6 months (Mid-Term), and 12-15 months (Long-Term). FoF was measured using the Falls Efficacy Scale-International (FES-I) questionnaire. PTSD was measured using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (DSM) Text Revision-5 (PCL-5) questionnaire. 239 patients who met inclusion criteria were consented via phone and completed the emailed surveys.

Results
The patients in the long-term group were found to have significantly lower FES-I scores compared to the acute and mid-term groups (p=0.004). Post hoc testing was performed on this significant result and identified the significance is between the Acute and Long-Term groups (p = 0.001) (Figure 1). High concern for FoF was observed in 63% (19/30) of patients in the Acute group, in 35% (14/40) in the Mid-Term group, and in 19% (8/42) in the Long-Term group. The acute group had a significantly greater proportion of patients with high concern for falling compared to the mid-term and long-term groups (p=0.001). There was no significant difference between the PCL-5 scores between the acute, mid-term, and long-term groups (Figure 2). Probable PTSD was observed in 2.3% (1/44) of patients in the Acute group, in 4.8% (2/42) in the Mid-Term group, and in 7.3% (3/41) in the Long-Term group.

Conclusion
Patients who undergo surgical fixation of a distal radius fracture due to a fall are subject to Fear of Falling and PTSD symptoms. Fear of falling is highest in the first two weeks following operative fixation of a distal radius fracture due to a fall, with lower rates at 3-6 months and at 12-15 months. Post-traumatic stress symptoms can be prevalent up to a year post operatively, and potentially beyond. In order to maximize postoperative outcomes, it is important for surgeons to be aware of these psychological effects and know how to screen for them.


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