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