Orthopaedic Surgeons Need to Ask About Intimate Partner Violence

Fleming et al. report the results of a prospective study of adult patients presenting to fracture clinics after a fracture and agreeing to be enrolled and screened for intimate partner violence (IPV). This is an important topic to trauma surgeons and society, and I applaud the authors for this line of research. Prior data from 2011 showed a 2.5% rate (7 of 282 patients) of IPV causing injury among female patients presenting to orthopaedic fracture clinics at 2 Level-I trauma centers in Canada1, as well as 8.5% having experienced physical violence and 32% having experienced physical, emotional, or sexual violence in the 12 months prior to their clinic presentation. In the current study, Fleming et al. report high rates of lifetime IPV in participants of all genders, with gender-diverse patients reporting a 100% rate of lifetime IPV. However, none of the patients in the current study sustained the injuries that caused them to present to the clinics as a result of IPV. Because these data were only gathered in orthopaedic fracture clinics, it is possible that similar rates of IPV could be found in the general population or other subspeciality clinics in all parts of medicine. When I read the article title, my first thought was that the patients presenting to an orthopaedic trauma clinic had IPV as a cause of the injury and that this led to poorer outcomes. I encourage the readership to pay close attention to the entirety of this article to better understand the findings and potential implications. My takeaways from this article are that patients presenting to orthopaedic trauma clinics have high rates of emotional, sexual, or physical abuse at some point in their life, but that IPV was not the cause of injury in any participant in this cohort. This lifetime history of IPV is important and needs to be addressed by society. The next questions are the implications of this publication and what should be done next. This current study was also limited by the inclusion of only English-speaking patients, and those speaking other languages may have different rates of lifetime IPV. I believe that it will be important to gather data regarding patients seen in specialty clinics outside of orthopaedic trauma and patients who speak languages other than English, to help to light the best path forward to improve the lives of those affected by IPV. Regardless, orthopaedic surgeons need to be asking questions about IPV and other types of domestic violence and maintain a heightened index of suspicion, much like for child and elder abuse, with any patient presenting for fracture care and use their institutional resources to best support those patients who need intervention.