Lead Article – September 2021

Orthopaedic Injuries Can Make You Mad

I am using the word “mad” quite loosely.  I am not suggesting that the orthopaedic injury will give rise to psychiatric or mental illness but instead, can be irritating, frustrating, give rise to anger and anguish and generally making you “mad”.  We all feel this type of frustration from time to time.  Some inciting agents are more provocative than others.

There is another dimension to explore.  That relates to the patient who has had an orthopaedic injury but follows a course contrary to the expected natural history.  Minor soft tissue injuries, strains and sprains typically heal quite promptly.  To see a patient five years later with a symptom spectrum unchanged, suggests that there is far more to it than just the simple orthopaedic condition.

These patients may be truly mad, suffering with some form of psychiatric illness.  Importantly, the relatively minor orthopaedic accident may have been the precipitant for the psychiatric demise.  Had it not been for the accident, the patient may have continued on a seemingly normal course indefinitely.

I see these patients from time to time.  I outline my views on the likely contribution of the orthopaedic injury to the circumstance but also make reference to the need for psychiatric investigation and care.

Typically, I hear no more about the case.  I genuinely hope that the advice has been followed and that some form of respite is eventually achieved.