Forearm fracture may be red flag for domestic violence, study finds

BOSTON — A certain type of forearm fracture may be a red flag for detecting domestic violence, a new study found, giving healthcare workers hope of preventing further abuse.

The ulna – the bone in the forearm that stretches from the pinky finger to the elbow – is often broken when a person raises their arm in front of their face or body in self-defense and is struck. The resulting break, called a non-displaced fracture, could be a telltale sign of domestic violence, Dr. Bharti Khurana found.

The breaks are traditionally known as “nightstick fractures,” because they are often seen among people who attempt to block blows from police officers carrying the weapons.

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Khurana, an emergency radiologist at Brigham and Women’s Hospital, had seen male patients with such fractures for years before it occurred to her similar injuries women were suffering might have been due to intimate partner violence.

“This is where I thought of working on this particular fracture, because I thought this could be a very specific fracture,” Khurana said. “So I spoke to our orthopedic surgeons, all three senior orthopedic surgeons, and all three got excited. So, we started the studies.”

Khurana led the study that looked at the records of female patients from six local hospitals, between the ages of 18 and 50, with ulna fractures only.

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Of the 62 patients they identified in cases ranging from 2005 to 2018, Khurana and her colleagues found about one-third of them had admitted to or were suspected of being victims of intimate partner violence.

Many victims who do not disclose their abuse hide it from doctors and nurses by claiming to have fallen. But ulna fractures resulting from falls are rare; the typical forearm fracture one suffers from falling is to the radius, the other forearm bone, Khurana, a trauma imager, told Boston 25 News.

“Often, adult victims are uncomfortable sharing, maybe because of shame or fear,” Khurana said.”And they often end up risking their own lives, because they are not going to share this information.”

Research shows domestic violence has increased during the coronavirus pandemic, while access to abuse prevention programs and the ability to escape to a family member or friend’s house have been limited.

In the first few weeks of the lockdown, Khurana said, domestic violence victims were coming to the emergency room only with extreme cases.

“People were feeling uncomfortable coming to the E.R., because of Covid,” Khurana said. “There were few cases, but those case were very severe. So, we started seeing stab injuries because of domestic violence.”

Doctors have also been limited in their ability to see bruises and other signs of abuse during virtual doctor’s visits. Healthcare workers often do not conduct domestic violence screenings through Telehealth, because it’s unclear if the patient is in a safe place during their visit.

“Anytime you have one episode and the victim comes and doesn’t talk about intimate partner violence, he or she goes back home, the same cycle will be repeated, and it gets worse,” Khurana said. “Towards the end, we start seeing severe and life-threatening injuries. And of course… more than 50 percent of female homicides each year are linked to intimate partner violence. So, we want to avoid that late stage.”

While the results of the study may be startling, they could also be helpful. Khurana hopes early detection of domestic violence will allow clinicians to get victims help sooner and prevent abuse from escalating.

“We do see cases of late stages, like strangulation, and then we already have a known history of intimate partner violence. But we never make any attempt to diagnose it before,” Khurana said. “If this can be addressed earlier, it’s easier to break that violence cycle earlier.”

The study will be presented at the Radiological Society of North America. Khurana hopes awareness will lead to more data from other hospitals, and eventually ulna fractures, in part, will become a marker for intimate partner violence.

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