S10.2 PSYCHOLOGICAL ASPECTS IN PRIMARY POST TRAUMATIC OSTEOMYELITIS AFTER ACCIDENTS

Abstract

According to the International Classification of Psychic Disturbances (ICD 10) accidents are among the traumatic incidents in a person’s experience and can lead to acute or persisting post traumatic strain reactions. During the primary medical treatment and care the patient first of all has to come to terms with the consequences of the accident. If an acute osteomyelitis occurs later on, this will be a further strain on the patient’s convalescence. At this point in time the extent of this infection is not foreseeable, neither for the team treating the patient nor for the patient him/herself. While the accident itself is to be seen as an acute trauma, the development of a chronic infection is a creeping and uncertain process. On the one hand the patient is confronted with the psychic effect of the accident and its consequences and on the other hand with the psychic effects of drawn-out treatment.

Apart from functional restrictions and cosmetically straining outcomes the patients suffer under the social effects, such as loss of work and threats to finances, changes, or loosing a partner and the social surroundings and restrictions in leisure activities. The psychological effects of chronic strain are a depressive attitude, loosing control when acute pain occurs, a decrease in sexual needs, alcohol or medication abuse and not rarely a permanent change in personality. Added to this are worries about the future, fear that the infection can “flare-up” again or the necessity of an amputation. According to the literature the existence of chronic pain is the most serious influential factor on a patient’s quality of life.

The question which personality factors contribute to the development of chronic osteomyelitis has not been answered to date. Investigations only show a connection between patients with psychiatric illnesses and a higher liability to be ill. Klemm et al. (1988) specified that for a small group of patients psychosomatic factors are involved in the “definition” (but not the cause) of chronic osteomyelitis.

The psychological treatment deals with the results of the accident and the effect of the drawn-out treatment.

Starting point is a detailed psychological and social requirement and problem orientation with an active analysis of problems and to look for resolutions. A subjective appraisal of the illness, the psychic resilience, intellectual abilities, cognitive handling strategies, personal and social resources all have a decisive effect on the progress of the therapy.