The quality of life during the treatment of long bone fractures in children and adolescents

Jonovska, Suzana and Šendula Jengić, Vesna and Kvesić, Ante and Pavlović, Eduard and Župančić, Božidar and Galić, Gordan and Klarić, Miro and Klarić, Branka (2008) The quality of life during the treatment of long bone fractures in children and adolescents. Collegium Antropologicum, 32 (4). pp. 1121-1127. ISSN 0350-6134

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Abstract

This paper evaluates and compares basic emotional reactions towards the illness, as well as the quality of life in relation to the various types of treatment of isolated long tubular bone fractures of extremities in children and adolescents. This prospective clinical research comprehends 135 patients (94 males and 41 females), aged 10 to 18, treated for the mentioned bone fractures in the period from October 2003 till March 2005 at The Departments for Pediatric Surgery of three hospitals: the Clinical Hospital Centre in Rijeka (88.8% of the patients), the Clinical Children's Hospital in Zagreb (9.7% of the patients) both in Croatia, and 1.5% of the patients in the Clinical Hospital in Mostar (Bosnia and Herzegovina). 53.3% of the patients were treated conservatively, 29.6% of them underwent the elastic stable intramedullary nailing (ESIN), while the remaining 17.1% of the patients were treated with other surgical techniques (AO-plates or Kirschner-wire ostheosyntheses). The basic methods were self-reported questionnaires: the Spielberg State Trait Anxiety Inventory (STAIl) to establish momentary anxiety and the Short Form-36 Health Survey (SF-36) to evaluate quality of life, i.e. the perception of the illness during treatment. The STAI1 was administered twice to the patients: within 1 week of the experienced trauma (at baseline) and 6 months after the trauma, whereas the SF-36 was administered only once, i.e. a month after the experienced trauma. Our results point at an increased anxiety indicators in all the patients immediately after the experienced trauma, mostly in patients treated surgically, especially those who underwent the ESIN method; whereas after 6 months from the experienced trauma the anxiety indicators were greatly reduced. The quality of life was better in patients who underwent a conservative treatment, both physically and mentally, than in those surgically treated. This points to the fact that the surgical method itself despite its type, is an additional stressor which causes additional anxiety and depressive reaction. Our results suggest (from psychological point of view) that the conservative method of treating long bone fractures in children and adolescents should be used since it causes less emotional reactions on the illness ascertaining a better health experience during the treatment than the active surgical treatment (regardless of the type), which should be practised with criticism and according to strict surgical indications. If the surgical treatment should be necessarily adopted, we should take into consideration the possibility of psychologically preparing the patients in order to diminish the psychological reaction on the surgical treatment.

Abstract in Croatian

Ovaj članak evaluira i uspoređuje osnovne emocionalne reakcije na bolest i kvalitetu života djece i adolescenata različito liječenih zbog izoliranih prijeloma dugih cjevastih kostiju ekstremiteta. Radi se o prospektivnom kliničkom istraživanju koje obuhvaća 135 pacijenata (94 muškog i 41 ženskog spola), dobi 10–18 godina, liječenih zbog navedenih koštanih prijeloma u razdoblju od listopada 2003. do ožujka 2005. godine na Odjelima za dječju kirurgiju triju bolnica, i to: Kliničkog Bolničkog Centra u Rijeci (88,8% svih pacijenata) i Kliničke Dječje Bolnice u Zagrebu (9,7% svih pacijenata), obije u Hrvatskoj, te 1,5% svih pacijenata u Kliničkoj Bolnici u Mostaru (Bosna i Hercegovina). 53,3% svih pacijenata bilo je liječeno konzervativno, 29,6% elastičnom stabilnom intramedularnom osteosintezom (ESIN metodom), dok ostalih 17,1% pacijenata drugim kirurškim metodama (poput osteosinteza A–O pločicama ili Kirschnerovim žicama). Osnovne metode rada bili su slijedeći samoprocjenski upitnici: Spielberg State Trait Anxiety Inventory (STAI1) za utvrđivanje trenutne anksioznosti pacijenata i Short Form-36 Health Survey (SF-36) za utvrđivanje kvalitete života pacijenata, odnosno njihove percepcije bolesti tijekom liječenja. Upitnik STAI1 pacijenti su ispunili dvokratno i to unutar 1 tjedan od doživljene trauma i 6 mjeseci nakon traume, dok upitnik SF-36 bio je ispunjen jednokratno i to 1 mjesec nakon traume. Rezultati ovog istraživanja ukazuju na povećanu anksioznost u svih pacijenata neposredno nakon traume, većinom u pacijenata liječenih kirurški pogotovo onih ESIN metodom; dok nakon 6 mjeseci od trauma, anksioznost se značajno reducirala kod svih. Kvaliteta života, kako u kategoriji tjelesnog, tako i u kategoriji psihičkog zdravlja, bila je bolja u konzervativno liječenih pacijenata, nego u onih liječenih kirurški. Sve to ukazuje na činjenicu da je kirurško liječenje samo po sebi, bez obzira na vrstu, dodatni stressor koji uzrokuje dodatnu anksioznu i depresivnu reakciju. S psihološke točke gledišta, rezultati sugeriraju da se može računati na konzervativno liječenje prijeloma dugih kostiju u djece i adolescenata jer izaziva manje emocionalne reakcije na bolest i osigurava bolji doživljaj zdravlja pacijenata tijekom liječenja nego aktivno kirurško liječenje, bez obzira na vrstu, koje bi se trebalo koristiti kritički i striktno prema kirurškim indikacijama. U sličaju kada se kirurško liječenje nužno mora primjeniti, trebala bi se uzeti u razmatranje i mogućnost psihološke pripreme pacijenata s namjerom izbjegavanja psihološke reakcije na kirurško liječenje.

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