Demographics and Fracture Patterns of Patients Presenting to US Emergency Departments for Intimate Partner Violence

Orthopaedic surgeons are in a position to assist in identifying intimate partner violence (IPV) patients. It was the purpose of this study to analyze the demographics and fracture patterns of IPV patients in the United States. Data from the National Electronic Injury Surveillance System All Injury Program from 2005 through 2013 were used. Injuries due to domestic violence were identified, and statistical analyses accounted for the weighted, stratified nature of the data. There were 1.65 million emergency department visits over nine years for IPV. The median age was 29.8 years, 83.3% were women, and 55.3% occurred at home. The major diagnoses were contusion/abrasions (43.4%), lacerations (16.9%), strain/sprains (15.6%), internal organ injuries (14.4%), and fractures (9.7%). The most common fracture involved the face (48.3%), followed by the finger (9.9%), upper trunk (9.8%), and hand (6.4%). The highest proportion of lower extremity fractures occurred in men, and upper extremity fractures increased with increasing age. The odds of fracture in an IPV patient were greatest in those sustaining an upper extremity injury (odds ratio [OR] = 6.62), lower extremity injury (OR = 6.51), upper trunk injury (4.28), and head/neck injury (OR = 3.08) compared with a lower trunk injury (referent), and women (OR = 1.80) compared with men (referent). Older patients sustaining IPV had higher odds of a fracture (the few patients 10-14 and >65 years old were excluded from this analysis). As this study encompasses the entire United States, these results are germane to all US orthopaedic surgeons. Knowing typical fracture patterns/locations is helpful in identifying IPV patients, although the victim may not fully divulge the history and details of the event. Identification is important for the physical and mental health of the victim, and abuse often continues if intervention does not occur. The odds of a fracture in an IPV patient are greatest when the injury involved the extremities and increased with increasing age of the patient.