Early Post-Traumatic Stress Response Within 30 Days in School-Age Children and Adolescents With Simple Upper Extremity Fractures: Effects of Surgical Treatment

Background: This study examined the early (30-d) course of post-traumatic stress symptoms after simple upper extremity fractures and factors associated with symptom progression. Methods: A total of 109 children with simple upper extremity fractures were included in the study; patients were treated with either surgical or conservative (cast) methods. Child Posttraumatic Stress Symptom Scale (CPSS) scores from the pre-trauma period were assessed retrospectively on day 7; follow-up CPSS assessments were conducted prospectively on days 7 and 30 after the trauma. The subscales of re-experiencing, avoidance, and increased arousal were recorded at the same time points. The subjective impact of the event was measured using the Impact of Event Scale-Revised on day 7 (IES-R 7) and day 30 (IES-R 30). Random-effects linear mixed models were established at the patient level; fixed effects included time, age, BMI, sex, AO classification, trauma mechanism, surgery, cast type, and parental status variables. The effects of surgical treatment and trauma mechanism on changes in post-traumatic stress disorder (PTSD)-related symptoms over time were evaluated. Results: Total CPSS score increased from baseline at day 7 (β≈4.1, P <0.001) and returned to baseline levels at day 30. The subscales showed similar increases at day 7 and approached normal at day 30 (all P <0.001). Older age was associated with higher total CPSS, particularly re-experiencing. Surgical treatment was independently associated with higher total CPSS (β≈1.7, P ≈0.03) and re-experiencing and avoidence scores. The increase on day 7 was ~2.8 points higher in the surgical group (time × surgery, P ≈0.002); the between-group difference reached ~3.5 points on day 7 and disappeared by day 30. IES-R scores decreased by ~4.6 points from day 7 to day 30 ( P <0.001). Conclusions: PTSD symptoms after simple upper extremity fractures mostly emerge within the first week and largely subside within a month. Although surgery is associated with a higher symptom burden in the early period, this difference diminishes by day 30; therefore, surgery should not be avoided in clinically necessary cases. Level of Evidence: Level II.