Priority 3 from the Complex Fractures PSP

UNCERTAINTY: What psychological support would be useful for patients with complex fractures and when?  (JLA PSP Priority 3)
Overall ranking 3
JLA question ID 0105/3
Explanatory note

Complex fractures may lead to psychological morbidity in multiple ways. Firstly, the index injury may have been psychologically traumatic. Second, scarring and deformity may lead to issues with body image. Third, challenges may relate to changes in function and knock-on effects around work and leisure.


Psychological wellbeing is mentioned in NG37 as a study outcome. The guideline also advises mental health team involvement for patients with psychological or psychiatric risk factors though there is no evidence supplied relating to this.

No other relevant trial evidence Cochrane/PUBMED since 2015.

NICE Guideline 37 Fractures (complex): assessment and management

Health Research Classification System category Injuries and accidents
Extra information provided by this PSP
Original uncertainty examples Impact on patient psychological well-being/ future function following complex trauma. Can this be improved/ optimised with psychological support during rehab? ~ Psychology input from early stage ~ When is psychological support more beneficial to patients, inpatient or outpatient? ~ Assessment for anxiety ~ What can be done to bring forward the psychological support/treatment during rehabilitation? 
Submitted by 7 x Physio, 4 x Psychologist, 20 x Surgeon/Doctor, 4 x Unknown, 8 x Healthcare Professional (unspecified), 1 x Knows a patient, 9 x Patient, 3 x Nurse
PSP information
PSP unique ID 0105
PSP name Complex Fractures
Total number of uncertainties identified by this PSP. 58  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 8th June 2021