One in six women who come into fracture clinics have been abused by their partners in the last year, and at least one in 50 are there as a direct result of a domestic violence incident, according to a new study out of McMaster University.
The study, published Tuesday in The Lancet, shows that one in six there for ailments such as fractured bones, broken jaws and missing teeth have suffered physical, emotional or sexual violence.
The results are a concern, said Dr. Mohit Bhandari, a professor of orthopedic surgery at McMaster, who co-led the study.
By the time a woman receives broken bones, she's at sharp risk of being killed by her partner. That's why orthopedic surgeons need to get better at noticing the signs, he said.
"This for us has been a red flag to say 'This is an opportunity we cannot miss.'"
The findings are the result of a study that included 12 fracture clinics across Canada, the U.S., the Netherlands, Denmark and India. The Canadian component included clinics in Hamilton, Vancouver and Halifax.
The 2,945 participants answered direct questions about abuse and completed two private questionnaires. Sixteen per cent of women had experienced violence from their partners in the past year, and one in three had experienced it at some point during their lives.
Of the women there who were injured as a direct result of violence, most had never been asked about it by a health-care professional, Bhandari said.
Bhandari's interest in the subject began while working in Minneapolis 10 years ago. A female patient came in with a painful shoulder fracture, but her story didn't match the severity of the injury, he said.
It was perplexing, Bhandari said, but he focused on the mechanics of the injury. He later learned she had been pushed down the stairs.
Head injuries common
Neck and head injuries are the most common for women who have experienced domestic violence, he said. Also common are "bruising or broken jaws, teeth being knocked out, black eyes."
Victims of violence also have dislocated elbows, wrists and shoulders, or twisted or broken ankles, he said.
Health-care professionals in injury clinics are well positioned to identify patients experiencing domestic violence, said Bhandari, who is also an orthopedic surgeon with Hamilton Health Sciences. It shows that more orthopedic surgeons should educate themselves and be trained to ask questions.
"In keeping up our oath, which is quite frankly to do no harm, sometimes by doing nothing, we may in fact be doing harm."
Real numbers could be higher
The numbers don't surprise Clare Freeman, executive director at Hamilton Interval House. In fact, she says they're likely a little low.
Women experiencing partner violence are at different stages of disclosure, which affects how they answer questions, she said.
The study is important, she said, and "there is definitely a need" for it.
Asking patients about domestic violence should be combined with educating health-care workers on when to ask, and what to do about the response, said Diana Tikasz, director of the Domestic Violence/Sexual Assault Care Centre at Hamilton Health Sciences.
"It's critical that that piece happens first."
The study showed that nearly three-quarters of participants believed that health-care providers should ask women about intimate partner violence. About two-thirds thought orthopedic surgeons were well positioned to do so.