This Type of Fracture May Indicate Intimate Partner Violence

A study that will be presented at the annual meeting of the Radiological Society of North America found that about a third of women who present with forearm fractures may have suffered intimate partner violence.

Senior study author Bharti Khurana, MD, a radiologist at Brigham and Women’s Hospital in Boston, said she often saw ulna fractures in male patients, but sometimes saw them in female patients, too.

“I would see these types of injuries in men, but once in a while I would see them in women,” she explained. “I never correlated it with intimate partner violence until recently. I shared my thoughts with our orthopedic surgeons and, with their interest and support, decided to pursue the study.”

Dr Khurana and her colleagues searched electronic medical records from six hospitals for women aged 18 to 50 years with isolated ulnar fractures between 2005 and 2019. Four patient groups were created, based on self-reporting as well as injury documentation per EMS: confirmed intimate partner violence, suspected intimate partner violence, suspected unrelated to intimate partner violence, and confirmed unrelated to intimate partner violence.

Sixty-two women with an average age of 31 years were included in the analysis; intimate partner violence status was confirmed in 11, suspected in 9, suspected unrelated in 8, and confirmed unrelated in 34, according to the authors’ abstract. Factors determined not to be related to intimate partner violence with or without suspected cases were patient language, race, ZIP code, wealth index, marital status, religion, alcohol/IV drug abuse, and psychiatric history.

A strong correlation was identified between intimate partner violence and minimally displaced fractures.

“The radiological characteristics we were looking at were the location of the fracture, the pattern of the fracture in terms of how it broke, and the displacement of the fracture,” said study lead author David Sing, MD. “Out of all those things, what we usually saw was a minimally displaced fracture, meaning the bone is broken all the way through but has not shifted significantly.”

Women who experience intimate partner violence often attribute their injuries to a fall, but falls are much more likely to result in a radius fracture, said Dr. Khurana.

“It’s actually rare to break your ulna in a fall,” she explained. “If a radiologist is seeing an ulnar fracture that is non-displaced, and the woman says she had a fall, it’s actually quite concerning for intimate partner violence.”

“The sooner we can address and change the behavior, the better,” she added. “Just like radiologists want to diagnose cancer as early as possible, it’s the same thing with this. If we diagnose early, we have a better chance to break the cycle of violence.”