CORR Insights®: What Is the Prevalence of Intimate Partner Violence and Traumatic Brain Injury in Fracture Clinic Patients?

Where Are We Now?

As orthopaedic surgeons, we treat patients with fractures by putting together a picture using the patient’s background, age, medical history, demand, and risk factors. We study the imaging and decide how we will treat a given patient’s fracture. When these injuries heal in appropriate alignment and patients regain ROM and strength, we consider it a win. But if we miss an opportunity to recognize that our patients are experiencing partner-inflicted violence and they go on to sustain more injury and even death by homicide, we are far from victory.

We know that the prevalence of intimate partner violence (IPV) among women presenting with orthopaedic injuries is high (one of six women in the past year and one of three over a lifetime) [4]. The comorbid incidence of traumatic brain injury (TBI) is unknown. In this study, Turkstra et al. [7] found the prevalence of IPV in the previous year among patients in orthopaedic fracture clinic to be 20%, with the conditional probability of 66% that those patients had TBI. The prevalence is staggering. As surgeons, we have received the call to action pointed out by this work—we need to take real-world, practical steps to identify and treat IPV and TBI for the benefit of our patients.

Where Do We Need To Go?

We need a quick and easy screening tool for patients that can be used by a busy clinician to ask the right questions and recognize and treat IPV and TBI appropriately. The authors [7] cite the Woman Abuse Screening Tool [1] as used by the PRAISE investigators [5, 6], asking patients at every clinic visit if they have ever been physically, sexually, or emotionally abused by an intimate partner (with the options of always, sometimes, and never). Screening for TBI was done using a slightly more time-consuming tool, a 3-minute to 5-minute structed interview (the Ohio State University Traumatic Brain Injury Identification Method [2]).

Another unknown is the degree to which patients follow through with the suggestions we offer when we have identified that IPV has occurred. It’s not enough to give someone the name of a shelter or the phone number of a social worker. We need to take specific steps to protect our patients, and then study whether those steps have taken place and determine whether our patients actually stay safe.

How Do We Get There?

The Woman Abuse Screening Tool is quick and practical enough to implement at clinic visits. Additional training for surgeons and staff is available at resources cited by the authors (https://www.ipveducate.com/theeducate-training-program) and the Abused and Brain Injured toolkit (https://abitoolkit.ca/). Both are practical ways to educate ourselves and our staff about IPV and TBI. There are resources in these about where we can refer patients to get help.

A follow-up study to the current paper in CORR® [7] could be performed by asking patients in whom IPV and/or TBI were identified about whether they took advantage of the resources provided. In an anonymous manner, perhaps the agencies to whom we refer our patients to end the cycle of IPV could give data on the number of patients who took advantage of the resource. It would be useful to abstract hard data to determine the next step after identifying these patients to show us whether it is worthwhile to use the screening tools to identify patients experiencing IPV and TBI.

The authors cite a study called “‘I’ve never asked one question.’ Understanding the barriers among orthopedic surgery residents to screening female patients for intimate partner violence” [3] about IPV in reference to orthopaedic residents. As a trainee, I do not remember asking screening questions about IPV. Future studies should characterize with what frequency orthopaedic residency programs are teaching their trainees to screen and to what extent screening is being done at training facilities. These could be survey studies among residency programs. Knowledge of the baseline extent to which screening is done would pave the way for implementing training and use of resources during orthopaedic residency.