McMaster University

McMaster University

Faculty of
Health Sciences

Orthopedic surgeons can help uncover intimate partner violence

by Suzanne Morrison
Published: July 8, 2009
Mohit Bhandari
Dr. Mohit Bhandari, associate professor of orthopedic surgery in the Michael G. DeGroote School of Medicine

Studies show Canadian orthopedic surgeons believe intimate partner violence is rare, yet an estimated 653,000 Canadian women are involved in abusive relationships annually — suffering fractured bones, cuts and bruises.

This perception is expected to dramatically change because of initiatives led by Dr. Mohit Bhandari, associate professor of orthopedic surgery in the Michael G. DeGroote School of Medicine at McMaster University and Canada Research Chair in Musculoskeletal Trauma and Surgical Outcomes.

Bhandari, whose research concentrates on uncovering novel strategies to improve outcomes following orthopedic injuries, is expanding his research to include intimate partner violence. Currently, he chairs a committee of orthopedic surgeons and social work experts which has been investigating how orthopedic surgeons could better help abused women.

On behalf of the Canadian Orthopedic Association, the committee developed the association’s first formal position on the orthopedic surgeon’s role in the care of abused women.

Bhandari launched the statement at the association’s annual meeting in Whistler, British Columbia recently. With him was orthopedic surgeon Dr. Brett Dunlop, associate clinical professor of surgery also from McMaster, who presented an overview of his own past cases where he now understands that he missed important clues which indicated these women’s injuries were the direct result of domestic violence.

"With this statement, we have made the first critical step in changing the paradigm of practice among orthopedic surgeons across Canada," said Bhandari. "Our early research suggests that 30 per cent of women presenting to orthopedic clinics with injuries ‘screen’ positive for abusive relationships. Surgeons, however, have never been aware that this was an issue and have done little (if anything) to uncover such abuse."

Building awareness of domestic violence and educating orthopedic surgeons is to be the organization’s focus for the coming year.

As a result, it is expected in the near future every woman who sees an orthopedic surgeon for injuries will be assured she is in a safe environment and won’t be ridiculed if she discloses abuse. She will also be told psychological and social help is there if she needs it — either through the orthopedic surgeon or a hospital.

Bhandari said orthopedic surgeons have always felt victims of domestic violence are best cared for in hospital emergency departments. However, the reality is 80 per cent of women do not disclose what has happened to emergency room physicians and leave hospital without receiving the help they need.

Because orthopedic surgeons care for patients over a longer period of time, they have an opportunity to build a rapport with patients who may eventually feel comfortable enough to disclose what has happened to them, Bhandari said.

Just as fracture clinics now have osteoporosis nurses available to educate patients about how to prevent broken bones, Bhandari thinks in the future orthopedic surgeons will have allied health professionals, such as social workers, working alongside them to give additional assistance to victims of domestic violence.

To increase awareness, plans are underway for mail-outs, Canada-wide posters and the development of a help line.

The new statement by the Canadian Orthopedic Association is backed up by a 300-patient pilot study called PRAISE (Prevention of Abuse with an Intimate Partner Surgical Evaluation Study) conducted at Hamilton General Hospital in Hamilton and St. Michael’s Hospital in Toronto. About 30 per cent of women in the study said they were in an abusive relationship with three per cent admitting their injuries had just happened.

A larger cohort study is being planned which is expected to involve seven Canadian centres.

Bhandari recently moderated an international panel on the Global Burden of Trauma at the Osteosynthesis and Trauma Care Foundation leadership forum in Nice, France. Panel speakers discussed trauma in India, China, the Philippines, South America and Africa — all countries where Bhandari believes work can be done to educate orthopedic surgeons about the needs and care of domestic violence victims.

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