Lower incidence of new onset depressive mood disorders associated with early postoperative weight-bearing versus non-weight bearing following fixation of femur and tibia fractures.

introductionLower extremity fractures are common orthopaedic injuries and often require surgical intervention, which has been shown to significantly impact both the physical recovery and psychological well-being of patients. Given the high prevalence of psychiatric disorders following lower extremity injuries, understanding the relationship between postoperative weight bearing restrictions and psychiatric outcomes is important for improving patient recovery. It was hypothesized that patients with lower extremity fractures who were allowed early weight bearing postoperatively would have lower rates of new-onset psychiatric diagnoses.

methodsThe TriNetX U.S Collaborative Network database was used to identify patients without prior psychiatric diagnoses who underwent either intramedullary nailing (IMN) or open reduction and internal fixation (ORIF) for femur and/or tibial fractures. The IMN and ORIF cohorts were matched based on age, sex, race, diabetes mellitus, and obesity. Psychiatric outcomes included depressive and anxiety disorders, substance use disorders, and psychotropic medication prescriptions. Outcomes were compared at early (1-7 days), intermediate (7 days-2 months), and long term (2 months-2 years) postoperative periods.

resultsAfter matching, 7410 patients per cohort were included (IMN n = 7410; ORIF n = 7410; total N = 14,820). The rates of developing a new early (1-7 days) postoperative psychiatric diagnosis did not differ significantly between the IMN and ORIF cohorts. However, IMN was associated with a significantly lower rate of depressive mood disorders during the intermediate period (0.65% vs. 1.0%, p = 0.02) and over the two-year follow-up (3.1% vs. 3.7%, p = 0.03). After two years, IMN was associated with lower opioid use disorder compared to ORIF (0.20% vs. 0.50%, p = 0.012). There were no significant differences in the rates of anxiety disorders, substance use disorders, or psychotropic medication prescriptions at any timepoints.

conclusionsEarly weight-bearing facilitated by IMN may be associated with a lower incidence of depressive mood disorders compared to delayed weight-bearing with ORIF. However, overall psychiatric outcomes were similar in this study. This suggests that other factors such as pain management and rehabilitation may play a more important role in postoperative psychiatric health.