title: Impact of external fixation on adolescents: an integrative research review.
abstract: OBJECTIVE
  To define the state of nursing knowledge about the psychological impact of treating adolescents with external fixation devices (EFDs).
  
  
  METHODS
  An integrated research review was conducted on literature available from CINAHL, MEDLINE, and PsycINFO. Keywords used were external fixation, fracture fixation, orthopaedic or orthopaedic, limb lengthening, Ilizarov, halo traction, Orthofix, EBI fixator, pelvic fixator, ring fixator, body image, self-concept, self-esteem, self-perception, adaptation, emotional, behavior, and outcome. Inclusion criteria for studies were (a) publication from 1990 to 2003, (b) focus on psychosocial and functional outcomes of treating adolescents with EFDs, and (c) publication in English. Studies were categorized by author, year, discipline(s), design, focus, sample, measurement, findings, and research recommendations. Findings and recommendations were compared across publications.
  
  
  RESULTS
  All studies reported psychological and behavioral changes after EFD treatment. Pain and pin-site infections were the most problematic physical findings. Depression was universally evident to varying degrees, with some suicidal ideation and self-destructive behaviors, although mostly reported as transient. This predominantly retrospective cohort of studies reported social isolation as well as eating and sleep disturbances. Family and nursing support, a multiple disciplinary approach, and better preoperative preparation were crucial to adolescents psychological health after EFD treatment.
  
  
  CONCLUSIONS
  Adolescents treated with EFDs require significant psychosocial support. The findings reveal major gaps in the knowledge on adolescents treated with external fixation for traumatic injury and none focused on EFD treatment in the acute period.
authors.affiliation: University of Massachusetts Graduate School of Nursing, Department of Orthopedics, UMass Memorial Medical Center, Worcester, MA, USA.
authors.forename: Miki
authors.initials: M
authors.lastname: Patterson
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D041923:Adolescent Development; D001294:Attitude to Health; D001828:Body Image; D003863:Depression / Q000209:etiology / Q000523:psychology; D016267:External Fixators / Q000009:adverse effects*; D001068:Feeding and Eating Disorders / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D016530:Orthopedic Nursing / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D000297:Psychology, Adolescent; D012107:Research Design; D012189:Retrospective Studies; D012649:Self Concept; D016728:Self-Injurious Behavior / Q000523:psychology; D012893:Sleep Wake Disorders / Q000209:etiology / Q000517:prevention & control; D012934:Social Isolation; D012944:Social Support; D013405:Suicide / Q000523:psychology