To the Editor: Preexisting mental illness has posed a variety of challenges in surgical management amongst all surgical specialties, with orthopedics being no exception. As seen in the article, “Orthopedic patients with mental disorder: literature review on preoperative and postoperative precautions” by Yoo et al.,1) the nature of these challenges is heavily impacted by the specific nature of the mental illness and the orthopedic sequelae and/or interventions. Given the broad spectrum of mental illnesses and orthopedic conditions, it is important that a review explored overarching themes in the current literature. However, as the movement towards awareness continues, it is important that specific populations be examined, specifically the subpopulation of intentional fallers.
As briefly mentioned in the section, “Pre-injury mental disorders,” falls account for the largest portion of injuries in people with mental disorders. Since the coronavirus disease 2019 (COVID-19) pandemic, it was found in London that the proportion of patients with both a fracture and psychiatric illness has more than doubled, while the number of patients presenting due to a traumatic suicide attempt has more than tripled.2) Additionally, as mentioned by Yoo et al.,1) the nature of these injuries tends to be more severe and is associated with more complications.
In a study conducted by Giordano et al.,3) all patients who acquired > 3 skeletal injuries post-fall experienced complications, with acute infection occurring in over half of those who survived.
|