DOI: https://doi.org/10.36347/sasjs.2026.v12i10.002

Pages: 812-823

Background: Severe mental illness carries a documented excess of skeletal trauma, driven by behavioural risk-taking, self-harm, psychotropic effects on bone, and heavy psychoactive substance exposure. Whether that excess persists into the surgical outcome, and how it should reshape fracture strategy, remains poorly quantified outside high-income registries. Objective: To characterise the injury profile, hospital trajectory and operative results of limb fractures occurring in patients with a documented psychotic, bipolar or major depressive disorder, and to derive a practical management framework. Materials and Methods: Twenty-two consecutive patients older than 15 years, admitted over a two-year period to a single academic trauma unit in Marrakech with a limb fracture and an established psychiatric diagnosis, were reviewed retrospectively. Records lacking follow-up or complete documentation were excluded, as were anxiety, neurodevelopmental, eating and post-traumatic stress disorders. Demographic, toxicological, injury, treatment and complication variables were abstracted. Results: Mean age was 35 years, with 18 men and 4 women (male-to-female ratio 4.5). Dissociative psychosis predominated (16/22; 72.7%), ahead of bipolar disorder (4/22; 18.2%) and major depression with self-harm (2/22; 9.1%). Sixteen patients (72.7%) were not taking their prescribed psychotropic regimen and six (27.3%) were homeless. Tobacco (90.9%), cannabis (86.4%) and other substances (63.6%) were near-universal. Road traffic collisions caused 13 injuries (59.1%). The lower limb was affected in 13 cases (59.1%). Nineteen patients (86.4%) underwent surgery. Behavioural disturbance (86.4%), withdrawal states (86.4%) and antipsychotic refusal (54.5%) complicated the admission. Fixation-related failure occurred in 5 of 19 operated patients (26.3%), early surgical site sepsis in 4 (21.1%) and tibial nonunion in 3 (15.8%), one of which culminated in above-knee amputation (5.3%). Conclusion: Complicat