BOBÌåÓý

Even with excellent surgical outcomes, some patients with severe injuries to their musculoskeletal system face a complex recovery journey: Their scars aren’t just physical but deeply psychological, manifesting as PTSD, depression, and anxiety. Jennifer E. Hagen, M.D., an orthopaedic trauma surgeon at BOBÌåÓý Orthopaedics and Sports Medicine Institute, has made this shift in understanding â€� which has profound implications for orthopaedic patient care â€� a focal point in her research.

One promising avenue is early pharmacological intervention. Carol Mathews, M.D., and Ludmila Barbosa De Faria, M.D., of the UF Department of Psychiatry, along with Hagen and her team, recently concluded a study evaluating fluoxetine (Prozac) as a preventive measure for orthopaedic trauma patients at BOBÌåÓý Shands Hospital.

“We ran a pilot study randomizing trauma patients to fluoxetine right after their trauma for nine months to see if it lessened pain and negative mental health symptoms,� she said. “We just finished collecting data; while the final results are not yet available, they’re promising enough that we’ve started a blinded trial with Prozac vs. placebo.�

The rationale behind fluoxetine is practical: It’s one of the few medications approved for PTSD treatment, has minimal side effects and withdrawal symptoms, and is cost-effective. The study covered the patient’s medication costs, ensuring they did not appear on insurance records. Unfortunately, enrolling patients remained a challenge due to the lingering stigma around mental health care.

Despite such stigma, The American College of Surgeons now mandates trauma centers to screen for mental health issues.

“The challenge is that PTSD can’t technically be diagnosed until at least 30 days after the incident,� Hagen said. “A normal human response to a serious crash —especially one with a fatality � is grief, sadness, anger. That’s not necessarily a pathological process.�

BOBÌåÓý recently introduced routine screening of trauma patients with the Injured Trauma Survivor Screen, or ITSS, designed to identify patients at the most significant risk of developing PTSD and other mental health challenges early in their recovery journey. This innovative tool enables the team to screen patients shortly after trauma and conduct follow-ups at regular intervals, including six weeks, three months, and six months post-injury.

Recognizing the meed for mental health support

The pivotal role of mental health in recovery wasn’t always part of orthopaedic trauma care.

“In the late 1980s and early 1990s, the orthopaedic trauma field noticed that patients, even those who had healed with no infections and good radiographic outcomes, were not doing well overall,� Hagen said. “They weren’t going back to work; they were still on chronic pain medication and not thriving.�

The National Institutes of Health’s Lower Extremity Assessment Project, or LEAP, confirmed this observation. Initiated in the 1990s, followed hundreds of patients with severe extremity injuries, documenting the critical need to address both physical and psychological aspects of trauma recovery through its updates.

“As a surgical specialty, it was hard to wrap our minds around that because we were used to a more physical approach: fix the bone, the bone looks great, the patient goes back to their life,� she said. “But the data made it clear we needed to do something beyond our surgical techniques to help people.�

Hagen also pointed out that outcomes aren’t always tied to the severity of the injury or the patient’s socioeconomic status.

“We can’t predict who it will be yet, so don’t assume you know. Patients with traumatic brain injuries or spinal cord injuries have a higher rate of depression, but even for the average trauma patient, we must be alert. We’re not necessarily diagnosing or treating it ourselves, but we shouldn’t ignore it.�

She offers pragmatic advice for orthopaedic surgeons and trauma care providers on addressing mental health concerns in the clinic. “First, be able to talk about it,� she said. “Understand that patients may cry in the clinic and not from suture removal. Many want to talk.�

A brief five- to 10-minute conversation can make a difference: asking patients about self-harm thoughts, assessing their support systems, and determining if they’re willing to talk to a professional.

Looking ahead, Hagen is determined to answer pressing questions: Who is at the highest risk for persistent problems? How can hospitals systematize support for trauma patients? Could biological markers like stress-related hormones provide predictive insights?

“Mental health is not a side note � it’s integral to recovery,� she said. “We’re doctors, so it’s our responsibility to look out for the whole patient.�