Upper extremity injuries in the victims of intimate partner violence

Richard Thomas; George S M Dyer; Paul Tornetta Iii; Hyesun Park; Rahul Gujrathi; Babina Gosangi; Jordan Lebovic; Najmo Hassan; Steven E Seltzer; Kathryn M Rexrode; Giles W Boland; Mitchel B Harris; Bharti Khurana

doi:10.1007/s00330-020-07672-1

Upper extremity injuries in the victims of intimate partner violence

Eur Radiol. 2021 Aug;31(8):5713-5720. doi: 10.1007/s00330-020-07672-1. Epub 2021 Jan 18.

Affiliations

¹ Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
² Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
³ Department of Orthopedic Surgery, Boston Medical Center, 725 Albany St 4th Floor, Suite 4B, Boston, MA, 02118, USA.
⁴ Department of Orthopedic Surgery, Hospital for Joint Diseases, 301 E 17th St, New York, NY, 10003, USA.
⁵ Division of Women's Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
⁶ Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
⁷ Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. bkhurana@bwh.harvard.edu.

Abstract

Objectives: To recognize most common patterns of upper extremity (UE) injuries in victims of Intimate Partner Violence (IPV).

Methods: Radiological review of 308 patients who reported physical IPV at our institution from January 2013 to June 2018, identified 55 patients with 88 unique UE injuries. Demographic data and injury patterns and associations were collected from the electronic medical records.

Results: The cohort included 49 females and 6 males (age 19-63, mean 38). At the time of injury, IPV was reported in 15/88 (17%) and IPV screening was documented for 22/88 (25%) injuries. There were 46 fractures, 8 dislocations or subluxations, and 34 isolated soft tissue injuries, most commonly involving the hand (56/88). Fractures most commonly involved the fingers (21/46, 46%) and the 5th digit (8/27, 30%). Medial UE fractures (5th digit, 4th digit) constituted 44% of hand and finger fractures (12/27) and 26% of all fractures (12/46). Comminuted and displaced fractures were rare (8/46, 17%). Head and face injuries were the most common concomitant injuries (9/22, 41%) and subsequent injuries (21/61, 35%). Of 12 patients with recurrent UE injuries, 6 had recurrent injuries of the same hand. Five of 6 non-acute fractures (83%) were of the hand.

Conclusions: Hand and finger injuries are the most common UE injuries in patients with IPV, with finger being the most common site and medial hand the most common region of fracture. Repeated injuries involving the same site and a combination of medial hand and head or face injuries could indicate IPV.

Key points: • Upper extremity injuries in victims of intimate partner violence are most commonly seen in the hand and fingers. • Fingers are the most common site of fracture and the medial hand is the most common region of fracture in the upper extremity in victims of intimate partner violence. • In intimate partner violence victims with upper extremity injuries, concomitant injuries and subsequent injuries are most commonly seen in the head and neck region.

Keywords: Abuse; Domestic violence; Intimate partner violence; Radiology; Upper extremity.

MeSH terms

Adult
Female
Fractures, Bone* / diagnostic imaging
Fractures, Bone* / epidemiology
Humans
Intimate Partner Violence*
Male
Mass Screening
Middle Aged
Upper Extremity
Young Adult