Comments on the Article “Orthopedic Patients with Mental Disorder: Literature Review on Preoperative and Postoperative Precautions”: In Reply

Jun-Il Yoo, Yonghan Cha, Jung-Taek Kim, Chan Ho Park, Wonsik Choy, Kyung-Hoi Koo, Reply:

We thank you for the opportunity to respond to the interesting letter commenting about our literature review, “Orthopedic patients with mental disorder: literature review on preoperative and postoperative precautions”, published in 2022 of Clinics in Orthopedic Surgery.¹⁾

As you mentioned, discussions on the prevention and management of patients with mental illness attempting suicide through methods such as falls need to be further explored. This is not only within the clinical realm but should also be deliberated at the national and regional levels in terms of healthcare policy. Specifically, during the coronavirus disease 2019 (COVID-19) era, there was an observed increase in severe trauma resulting from fall injuries due to suicide in patients with mental illness. This not only posed challenges to the healthcare system but also prompted considerations on how to address similar issues during future pandemic periods.

We also wholeheartedly agree with your emphasis on the importance of preventing and managing orthopedic trauma in patients with mental illnesses, as well as addressing the prevention and management of mental health issues following trauma.

However, we would like to clarify that our current discussion has provided some clinical insights for orthopedic surgeons involved in the immediate care of patients with mental illnesses. Furthermore, we believe that the content of our review is applicable not only to trauma patients visiting the emergency room but also to those seeking outpatient care for various medical conditions.

We strongly agree with the notion that the approach to these patients should be multidisciplinary. However, we believe that there is still a significant risk associated with orthopedic surgeons making conclusions in the assessment and diagnosis of patients. Communication with specialists in mental health is also currently insufficient, in our opinion. We anticipate that ongoing discussions like these will lead to various changes, both clinically and within the healthcare system. Moving forward, we believe that diverse transformations will emerge in this regard.