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Objective: Previous fracture history of soldiers prior to compulsory military service is an important issue for both orthopedics and psychiatry departments of military hospitals. The aim of this study is to evaluate the psychiatric status of soldiers who had fractures before military service.
Methods: The data of patients admitted to the orthopedic outpatient clinic with complaints related to previous fractures for the term between January 2013 and November 2013 were examined retrospectively. Patients who had also been admitted to the psychiatry policlinic were included in the study and subjected to further investigation.
Results: One hundred and sixty-nine patients with previous fractures had been referred to the orthopedic department of our hospital over 10 months. 31 (18%) patients had a history of hand fracture and 26 (15%) patients had suffered elbow fracture. 44 (26%) of 169 patients were also referred to the psychiatry department. The fractures of 16 (36%) of the 44 patients had been treated surgically. Average psychiatric appeal was 2.6 times. 31 (70%) of these patients had an upper extremity fracture and most common fracture areas were hand (27%) and elbow (27%). The most common psychiatric diagnosis of these patients was adjustment disorder (72%). 3 patients had been diagnosed with dissociative disorder and 4 patients had been diagnosed with anxiety disorder. 3 patients had no psychiatric diagnosis. 13 (29%) patients had a substance use history, 9 (20%) patients had a self-mutilation history and 6 (13%) patients had a criminal record.
Conclusion: Hand and elbow fractures had been identified more prevalent in psychiatric disorder group than compared to the population of all fractures. A major cause of bone fractures, particularly that involving the forearm and hand is aggressive behavior. Another one is acting impulsively to endanger the physical integrity. These two behaviors with impulsive and aggressive features are the main symptoms of antisocial personality disorder. Likewise, psychoactive substance abuse and self-mutilation are further behavioral abnormalities belonging to the same personality disorder. Patients with antisocial personality disorder often have difficulty to adapt. These adaptation problems with the surroundings show itself in many areas of life. Compulsory military service has a special importance in our society, but on the other hand it is a stressful process. Some soldiers may experience adaptation problems. A high proportion of patients experiencing adjustment disorder are the ones who have an antisocial personality disorder. So, soldiers admitted to the orthopedic outpatient clinic with complaints related to previous fractures may also experience adjustment problems due to personality pathologies. Examination of the personality patterns of the study participants might have provided significant data about this issue in this study. Soldiers a with history of previous upper extremity fractures, especially hand and elbow, may have adjustment disorder during compulsory military service, so careful evaluation is required in terms of adjustment disorder in this group of soldiers.