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Orthopedic clinics urged to screen for domestic abuse: study

Orthopedic surgeons should consider screening all injured women for domestic abuse, according to a new study by Dr. Emil Schemitsch and others.

Toronto, January 11, 2011

Dr. Emil Schemitsch Dr. Emil Schemitsch

The study found that nearly one-third of women treated in two orthopedic fracture clinics in Ontario said they had been emotionally, sexually or physically abused by their partners in the past year.

The numbers are much higher than those reported in other medical specialties and higher than orthopedic surgeons believed. A previous study found the vast majority of orthopedic surgeons in Canada believed the prevalence of intimate partner violence in their practice was less than 1 per cent.

“Awareness is a big issue. Having done this research, we are a lot more aware, much more likely to be cognizant of the issue and think about it,” said Dr. Schemitsch, head of the division of orthopedic surgery. “If there is an issue, we ask a patient about it in a setting that is confidential, try to get the appropriate resources.”

The study, conducted at St. Michael’s Hospital and Hamilton Health Sciences, appears in the January issue of The Journal of Bone and Joint Surgery.

Of the 282 women studied, 32 per cent reported abuse in the past 12 months; 8.5 per cent experienced physical abuse; 30.5 per cent experienced emotional abuse; and 3.2 per cent experienced sexual abuse.

About 2.5 per cent said their injuries had just happened. Fractures were the most common type of injury, 73 per cent. The women were of all ages, ethnic groups and socio-economic status.

Very few of the women said they had ever been asked by another health-care professional whether they had been abused. The previous study of orthopedic surgeons found that one-third of them felt personal discomfort about intimate partner violence and more than half said they lacked knowledge about the topic.

The authors said that if their findings are extrapolated to most general orthopedic surgeons, there are numerous opportunities to identify and help abuse victims. A surgeon sees about 45 female patients a week, or 2,340 a year, half of whom are new, 1,179. Their findings suggest that screening all women would result in 99 women disclosing physical abuse over the previous year and 29 suffering injuries that were the direct result of abuse.

The numbers in the study may even be under-reported, Dr. Schemitsch said. Many women still feel ashamed of being victims of abuse, he said.

“The prevalence is a lot higher than anticipated,” he said. “We tend to think people come into fracture clinics with slip and fall issues, car accidents.” But in fact, many patients are victims of abuse, making fracture clinics an “unanticipated portal” for these women. “It shows there really is a need for screening and probably more intervention,” he said.

One solution might be for hospitals to have social workers in fracture clinics to deal with issues directly, he suggested.

The researchers said they believed their study was the first of its kind in fracture clinics in Ontario. Dr. Schemitsch said they are putting together a larger study of 3,000 women at 10 clinics in Canada (including St. Michael’s), Denmark, the Netherlands, Australia and the United States.

St. Michael's Emergency Department has recently implemented a similar program in which all female patients are asked whether they had been abused.