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Recognizing Isolated Ulnar Fractures as Potential Markers for Intimate Partner Violence
Bharti Khurana1, David Sing2, Rahul Gujrathi3
1Founder and Director, Trauma Imaging Research and Innovation Center, Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Associate Professor of Radiology, Harvard Medical School, Boston, Massachusetts.
Intimate partner violence (IPV) may cause up to one-third of isolated ulnar fractures in adult women. Nondisplaced fractures, homelessness, and frequent emergency visits suggest IPV.
Area of Science:
- Trauma surgery
- Forensic medicine
- Public health
Background:
- Intimate partner violence (IPV) is a significant public health issue.
- Fracture patterns can sometimes indicate the mechanism of injury.
Purpose of the Study:
- To determine the incidence of IPV in women with isolated ulnar fractures.
- To compare injury characteristics between IPV victims and other fracture causes.
Main Methods:
- Retrospective review of electronic health records from three level I trauma centers (2005-2019).
- Analysis of radiographs and demographic data for 62 women (aged 18-50) with isolated ulnar fractures.
- Stratification into IPV (confirmed, possible, suspected) and non-IPV groups; historical imaging analysis for IPV prediction.
Main Results:
- IPV was associated with nondisplaced ulnar fractures (95% vs. 43%, P < .001).
- Confirmed IPV cases showed higher rates of homelessness (46% vs. 0%, P < .001) and more emergency department visits (median 7.0 vs. 1.0, P < .001).
- IPV evaluation was formally documented in only 22.5% of patients; imaging predicted IPV in 75% of confirmed cases.
Conclusions:
- Up to one-third of adult women with isolated ulnar fractures may be victims of IPV.
- Radiographic nondisplacement, frequent ED visits, and homelessness are indicators favoring IPV etiology.
- Improved documentation and recognition of IPV in fracture patients are needed.
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