(Reuters Health) – Up to one in three women who seek emergency treatment for isolated ulnar fractures may be victims of intimate partner violence, a recent study suggests.
Researchers examined data on 62 women (mean age 31 years) treated for isolated ulnar fractures at one of three level-1 trauma centers from 2005 to 2019. Based on a clinical chart review, researchers identified 12 women with confirmed cases of intimate partner violence as well as 8 possible cases, 8 suspected cases that turned out not to be intimate partner violence, and 34 cases confirmed not to be intimate partner violence.
“Fractures to the ulna often occur when people hold up their hands to protect their faces from being struck with an object,” said lead study author Dr. Bharti Khurana, founder and director of the Trauma Imaging Research and Innovation Center and an associate professor of radiology at Harvard Medical School and Brigham and Women’s Hospital in Boston.
“These breaks are referred to as ‘nightstick fractures’ because they are frequently seen in people who try to block blows from nightsticks wielded by police officers,” Dr. Khurana said by email.
The radius, by contrast, is a stronger bone that gets more frequently fractured due to fall on an outstretched hand because the forces predominantly transmit through the radius, Dr. Khurana added. With fall, the most common fracture is of the radius, followed by both radius and ulna.
“It is sporadic to break ulna in isolation with fall,” Dr. Khurana said.
Half of the patients with suspected intimate partner violence who didn’t disclose it had reported an injury due to falls, however.
And among the 34 patients with isolated ulnar fractures confirmed to be due to causes other than intimate partner violence, only two patients reported a fall as the cause of the fracture. Most of them instead reported a motor vehicle accident or accidental striking.
Only 14 of the patients in the study (22.5%) had formal documentation of intimate partner violence screening in their medical records, the authors report in the Journal of the American College of Radiology.
Beyond its small size, another limitation of the study is the possibility that some women with isolated ulnar fractures don’t seek care, or that cases at a level-1 trauma center are not representative of all cases.
However, multiple fractures at the same time are extremely rare in adults, said Dr. Randall Loder, a professor emeritus of orthopedic surgery at Indiana University School of Medicine in Indianapolis who wasn’t involved in the study.
“Those are usually brought in by emergency medical services, with corroborating history to what the patient states unless the patient is unconscious due to head trauma, such as what is seen in motor vehicle crashes or falls from large heights,” Dr. Loder said by email.
With a non-displaced or minimally displaced ulna fracture in a young or middle-aged woman, however, clinicians should consider the possibility of intimate partner violence, especially if the patient account of the injury is nebulous, Dr. Loder said.
“In this particular circumstance, further inquiry by the health care providers or others such as social workers should be entertained,” Dr. Loder said.
SOURCE: https://bit.ly/3tMflqx Journal of the American College of Radiology, online April 3, 2021.
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