Domestic violence more common among orthopedic trauma patients than surgeons think

According to the World Health Organization, approximately 30 percent of women in North and South America experience intimate partner violence during their lifetimes. In North America, domestic violence also is the most common cause of non-fatal injuries among women, often resulting in broken bones.

However, research from the University of Missouri has found 74 percent of surgeons, who treat many victims of domestic violence, substantially underestimate the prevalence of domestic violence injuries among their patients, and only 23 percent had training to recognize such injuries.

"In our study, we found that most orthopaedic surgeons believe identifying injuries caused by domestic violence is an important aspect of providing medical care, and they also believe that receiving education to recognize signs of could help them to stop violence in some cases," said Gregory Della Rocca, M.D., Ph.D., an associate professor of at the MU School of Medicine and co-director of orthopaedic trauma services at MU Health Care. "In the United States, most orthopaedic surgeons receive training in techniques for recognizing signs of child abuse, but training to recognize abuse of adults is far less common. Only 23 percent of the surgeons we surveyed had received any training on recognizing and responding to intimate partner violence."

The study was based on a survey of 153 orthopaedic trauma surgeons, mostly in North America. The respondents were asked questions about the importance and ability for medical professionals to recognize and respond to signs of intimate partner violence, their beliefs about the causes of domestic violence, and estimates about the prevalence of domestic-violence injuries among their patients.

An international study of the prevalence of intimate partner violence among orthopaedic trauma clinics recently published in The Lancet found that 40 percent of North American patients reported having experienced violence. However, Della Rocca said his survey showed most orthopaedic surgeons significantly underestimated how often they see injuries, with 74 percent of orthopaedic estimating only 5 percent or less of their patients were victims of intimate partner violence. Della Rocca also was part of the steering and writing committees and the investigation team of 80 investigators for the study published in The Lancet.

"Based on our research about the high prevalence of intimate partner violence among orthopaedic trauma patients and the misconceptions about how common it actually is, I encourage to seek out education on the topic and learn about community resources where they can refer patients for help," Della Rocca said. "Since the publication of these studies, my orthopaedic surgeon colleagues at the University of Missouri and I have started screening all our patients—male and female—for intimate , and we are creating an educational program for training our orthopaedic surgery residents."

When Della Rocca and his colleagues find cases of violence, they collaborate with University of Missouri Health Care's social workers to provide patients information on community resources, such as counseling, women's shelters and legal protection.

More information: The study "Orthopaedic Surgeons' Knowledge and Misconceptions in the Identification of Intimate Partner Violence Against Women" was published in the journal Clinical Orthopaedics and Related Research in April 2013. The study "Prevalence of Abuse and Intimate Partner Violence Surgical Evaluation (PRAISE) in Orthopaedic Fracture Clinics: A Multinational Study" was published in The Lancet in September 2013. MU faculty members Brett Crist, M.D., and David Volgas, M.D., associate professors of orthopaedic surgery, also were co-investigators in The Lancet study.

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