Intimate partner violence

I enjoyed the article about a 66-year-old woman with spontaneous rib fracture, which focused on the importance of ruling out metastatic cancer and further discussion of other causes of nontraumatic rib fracture.¹ I would like to add to the differential diagnosis the possibility of intimate partner violence (IPV).

In a recent cross-sectional study of nearly 3000 women assessed at 1 of 12 orthopedic clinics in Canada, the United States, the Netherlands, Denmark and India, the PRevalence of Abuse and Intimate partner violence Surgical Evaluation (PRAISE) investigators found that 1 of 6 women surveyed had a history of IPV in the previous 12 months, 1 of 3 had experienced IPV in their lifetime, and 1 of 50 were attending an orthopedic clinic as a result of IPV.² In an earlier study at the Minnesota Domestic Abuse Program, investigators identified chest injuries in 8% of women assessed at the program, most of which were rib fractures.³

In the PRAISE study, of the women who were assessed because of an IPV injury, only 14% had been asked by a health care provider whether they were subject to IPV.² Although the case described in CMAJ is fictitious and describes a “spontaneous” or “nontraumatic” rib fracture, it should serve to remind primary care providers and specialists that there are many opportunities to engage in conversations with patients about IPV.