BACKGROUND: Some recent studies have suggested that certain types of orthopedic trauma result in ongoing disability and that factors other than injury severity or location may influence outcome. This study aimed to evaluate outcome 12 months and 2 years after severe orthopedic trauma, as measured on the Short Form (SF)-36 Health Survey, relative to a control group, to examine change over time and to examine which demographic, injury-related and psychological factors are associated with persisting disability. METHODS: One hundred thirteen orthopedic trauma patients, recruited during rehabilitation, and 61 demographically similar uninjured controls were followed up at 1 and 2 years postinjury. Measures included the SF-36 Health Survey, Symptom Checklist-90-R, Brief Pain Inventory, Hospital Anxiety and Depression Scales, and Posttraumatic Stress Disorder Checklist-Specific. RESULTS: Results indicated presence of significant ongoing disability in all SF-36 physical and mental health domains, significant ongoing psychologic adjustment problems, including posttraumatic stress disorder (PTSD) symptoms, and pain, with little or no improvement between 1 and 2 years postinjury. The presence of ongoing pain, anxiety, depression or PTSD symptoms were the strongest predictors of outcome on most variables, with older age also contributing to negative outcomes. Injury severity and type did not predict outcome, although those with lower limb fractures had greater pain and poorer physical outcomes that those with fractures in other locations. CONCLUSIONS: This study has highlighted pain and PTSD symptoms as frequent and disabling factors after othropedic trauma. There is clearly a need to focus on alleviating these problems as part of the rehabilitation process.