Beyond Fracture Healing: Pain, Functional Rehabilitation, and Psychological Outcomes Following Severe Pediatric Musculoskeletal Trauma

Severe pediatric musculoskeletal trauma represents a complex clinical condition with consequences extending beyond anatomical injury, affecting physical functioning, psychological well-being, and health-related quality of life. This narrative review aimed to analyze the relationship between pain, functional recovery, and psychological sequelae in children and adolescents experiencing traumatic musculoskeletal injuries, emphasizing multidisciplinary rehabilitation and international evidence, including Latin American perspectives. A descriptive and integrative approach was employed to examine 20 scientific publications addressing pediatric orthopedic trauma, analgesic management, functional rehabilitation, posttraumatic stress, and healthcare accessibility. The findings demonstrated that ibuprofen provided effective analgesia in uncomplicated pediatric musculoskeletal injuries, with several randomized trials showing no significant additional benefit from opioid-containing regimens. Longitudinal evidence indicated that physical impairment decreased from 44% at three months to 23% at twelve months following extremity fractures, while psychosocial impairment declined from 46% to 33%, suggesting distinct recovery trajectories. Psychological outcomes were heterogeneous, with a systematic review estimating posttraumatic stress disorder prevalence at approximately 15% following pediatric orthopedic trauma. Evidence also identified associations between pain intensity, psychological distress, and reduced health-related quality of life, although causal relationships remain insufficiently established. International differences in access to rehabilitation services further highlighted challenges in continuity of care, particularly within Latin American healthcare systems. Overall, the reviewed findings indicate that anatomical healing does not necessarily correspond to complete functional or psychological recovery. Comprehensive pediatric trauma rehabilitation should therefore incorporate individualized pain management, progressive functional restoration, developmentally appropriate psychological assessment, and family-centered support. Additional longitudinal and multicenter investigations are needed to clarify long-term recovery trajectories and evaluate integrated rehabilitation strategies in children with severe musculoskeletal injuries.