Incidence and determinants of acute stress disorder after supracondylar humeral fracture surgery in school-age children

Abstract

BACKGROUND

Supracondylar humeral fracture surgery represents a potential medical traumatic stressor in school-age children, yet data on the incidence of postoperative acute stress disorder (ASD) and its determinants in this population remain limited.

AIM

To determine the incidence of ASD after supracondylar humeral fracture surgery in school-age children and to identify independent risk and protective factors to support early risk stratification and targeted psychological interventions.

METHODS

A retrospective study design was employed, including 284 school-age children (aged 6-12 years) who underwent supracondylar humeral fracture surgery in the orthopedic department of our hospital from June 2023 to March 2025. Demographic characteristics, disease-related factors, and psychosocial factors were collected through a self-designed general information questionnaire. The Child ASD Scale was used to assess ASD symptoms. The Screen for Child Anxiety Related Emotional Disorders and Children’s Depression Inventory were employed to evaluate comorbid conditions. Multivariate logistic regression analysis was performed to identify independent risk factors and establish a predictive model.

RESULTS

Among 284 children, 23.6% developed ASD. The ASD group showed highest scores in intrusive symptoms and negative alterations in cognitions and mood dimensions. The detection rate of anxiety disorder was 55.2%, and depression symptoms was 46.3%, both significantly higher than the non-ASD group (P < 0.001). Multivariate logistic regression analysis revealed that Gartland type III fracture, severe pain intensity, postoperative complications, and previous trauma history were independent risk factors, while good family support was a protective factor. The predictive model showed good discrimination with an area under the curve of 0.823.

CONCLUSION

School-age children have a high incidence of ASD following supracondylar humeral fracture surgery, often accompanied by anxiety and depression symptoms. Fracture severity, pain intensity, postoperative complications, and previous trauma history are major risk factors, while good family support serves as a protective factor. Clinical practice should focus on high-risk patients, strengthen pain management, prevent complications, and provide family support interventions.

Keywords: Supracondylar humeral fracture; Acute stress disorder; School-age children; Risk factors; Psychological trauma

Core Tip: Acute stress disorder is a frequent but underrecognized psychological complication in school-age children after supracondylar humeral fracture surgery. In this study, 23.6% of children developed acute stress disorder, often accompanied by anxiety and depression. Multivariate analysis identified Gartland type III fractures, severe pain, postoperative complications, and prior trauma history as independent risk factors, while strong family support was protective. Our findings highlight the importance of early screening, effective pain control, complication prevention, and family-centered interventions to reduce psychological trauma and improve recovery in pediatric orthopedic patients.