Liu XC, Cao SH, Qu JM, Huang J, Li Y, Lu J, Xu JK. Influence of mental and psychological states on surgical outcomes following open reduction and internal fixation for trimalleolar ankle fractures. World J Psychiatry 2026; 16(8): 120504 [DOI: 10.5498/wjp.120504]
Corresponding Author of This Article
Jun-Kui Xu, Department of Foot and Ankle Surgery, Honghui Hospital, No. 555 Youyi East Road, Naanshaomen, Beilin District, Xi’an 710000, Shaanxi Province, China. 568720818@qq.com
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Orthopedics
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research-article
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Liu XC, Cao SH, Qu JM, Huang J, Li Y, Lu J, Xu JK. Influence of mental and psychological states on surgical outcomes following open reduction and internal fixation for trimalleolar ankle fractures. World J Psychiatry 2026; 16(8): 120504 [DOI: 10.5498/wjp.120504]
World J Psychiatry. Aug 19, 2026; 16(8): 120504 Published online Aug 19, 2026. doi: 10.5498/wjp.120504
Influence of mental and psychological states on surgical outcomes following open reduction and internal fixation for trimalleolar ankle fractures
Xiao-Cong Liu, Shi-Hang Cao, Jian-Min Qu, Jing Huang, Yi Li, Jun Lu, Jun-Kui Xu
Xiao-Cong Liu, Shi-Hang Cao, Jian-Min Qu, Jing Huang, Yi Li, Jun Lu, Jun-Kui Xu, Department of Foot and Ankle Surgery, Honghui Hospital, Xi’an 710000, Shaanxi Province, China
Author contributions: Liu XC wrote the first draft of the manuscript, collected and analyzed the data, and was responsible for software operation and data visualization; Cao SH supervised the study and performed data validation; Qu JM contributed to data collection, formal analysis, investigation, software, and visualization; Huang J assisted with data collection; Li Y and Lu J participated in manuscript review and editing; Xu JK conceptualized the study, acquired funding, provided resources, supervised the research, validated the results, and drafted, reviewed, and edited the manuscript. All authors have read and approve the final manuscript.
AI contribution statement: No AI tools were used in the preparation of this manuscript.
Supported by 2024 Provincial Science and Technology Development Project of Shaanxi Province, No. 2024SF-YBXM-379.
Institutional review board statement: This study was approved by the Ethics Review Committee of Xi’an Honghui Hospital, No. 2025-KY-030-01.
Informed consent statement: Due to the retrospective design and the use of de-identified patient data, the Ethics Committee waived the requirement for written informed consent.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Data sharing statement: Data will be provided if required.
Corresponding author: Jun-Kui Xu, Department of Foot and Ankle Surgery, Honghui Hospital, No. 555 Youyi East Road, Naanshaomen, Beilin District, Xi’an 710000, Shaanxi Province, China. 568720818@qq.com
Received: March 1, 2026 Revised: April 10, 2026 Accepted: June 4, 2026 Published online: August 19, 2026 Processing time: 139 Days and 18.2 Hours
Abstract
BACKGROUND
Ankle fractures, particularly trimalleolar fractures, represent some of the most severe lower extremity injuries and frequently require surgical intervention. Although open reduction and internal fixation (ORIF) reliably restores joint stability and function, postoperative outcomes exhibit considerable variability among patients. Emerging evidence indicates that preoperative psychological status may affect surgical prognosis. Nonetheless, the specific effects of anxiety and depression on outcomes following ORIF for trimalleolar fractures remain poorly understood.
AIM
To assess the impact of mental and psychological states on surgical outcomes in patients undergoing ORIF for trimalleolar fractures.
METHODS
A total of 525 patients with trimalleolar fractures who underwent surgery at Xi’an Honghui Hospital (October 2018-December 2023) were included. Patients were divided into two groups based on preoperative anxiety or depression: Group A (with anxiety/depression) and group B (without). Outcomes were assessed using Hospital Anxiety and Depression Scale, Visual Analogue Scale, American Orthopaedic Foot & Ankle Society Forefoot Score, EuroQol Five Dimensions Five Levels, and Central Sensitization Inventory. Spearman correlation analysis was used to examine the relationship between psychological status and functional outcomes.
RESULTS
Of the 525 patients, 467 completed the follow-up, yielding a follow-up rate of 88.95%. During the follow-up period, five patients developed postoperative limb swelling, and two patients experienced wound infections. Of the 467 patients, 231 (49.47%) had preoperative anxiety or depression symptoms. Postoperative assessment metrics showed marked improvement in both groups; however, the overall prognosis observed in group A remained inferior to that of group B.
CONCLUSION
ORIF for trimalleolar fractures effectively reduced pain, restored functional mobility, and improved patients’ psychological well-being. Patients presenting with anxiety or depression before surgery tended to experience less favorable prognostic outcomes.
Core Tip: This retrospective study of 467 patients demonstrated that preoperative anxiety or depression independently predicts poorer postoperative outcomes following open reduction and internal fixation for trimalleolar ankle fractures. Outcomes include increased pain, reduced functional recovery, heightened central sensitization, and diminished quality of life. Patients presenting with both anxiety and depression exhibited the worst prognosis, underscoring the importance of preoperative psychological assessment.
