Posttraumatic Stress Disorders in Civilian Orthopaedics (Report‪)‬

Posttraumatic stress disorder (PTSD) is an anxiety disorder that may develop after exposure to a traumatic stimulus. This disease entity has identifiable anatomic and physiologic correlates. Much of the research on PTSD has been done by the military because of the prevalence of traumatic stress in combatants, but PTSD also occurs in civilian orthopaedic patients. PTSD is a potential complication of adult and pediatric musculoskeletal trauma, including spinal or neurologic injury, complex fractures, multiligamentous knee injuries, and many other injuries. This disorder is encountered by generalists and subspecialists alike. Current diagnostic criteria established in the Diagnostic and Statistical Manual of Mental Disorders-IV Text Revision (DSM-IV-TR) require that the onset of symptoms be the result of exposure to an identifiable trauma and include three symptom clusters: reexperiencing (ie, nightmares, flashbacks, intrusive memories); avoidance and emotional numbing; and hyperarousal (ie, irritability, difficulty concentrating, insomnia, increased startle response).1 The duration of symptoms must be 1 month, and they must affect behavior (eg, avoiding a circumstance reminiscent of the inciting trauma). These specific diagnostic criteria demonstrate PTSD to be a distinct psychiatric entity different from depressive disorder and other anxiety disorders in etiology, phenotype, management, and prognosis. Severity of trauma is not included as a diagnostic criterion, and combat-level trauma is not a prerequisite for the development of PTSD. Orthopaedic injuries in civilians may result in PTSD. (1)