**The Missed Chance: Orthopedic Clinics and Recognition of Intimate Partner Violence**
The orthopedic clinic, with its distinctive scent of plaster and antiseptic, frequently turns into a predictable environment for routine check-ups and surgical assessments. Patients come for scheduled visits, like a knee replacement follow-up, during which surgeons carefully examine X-rays and evaluate the range of motion before planning further physical therapy. However, within this efficiency lies a persistent oversight—the concealed bruises that suggest a harsh reality of intimate partner violence (IPV) that often goes unrecognized.
A comprehensive 24-year analysis by Mass General Brigham highlights a significant gap in the healthcare framework: orthopedic surgeons refer only 0.3 percent of patients to intimate partner violence programs. This starkly contrasts with nearly 30 percent of referrals from emergency departments, shining a light on a considerable oversight in orthopedic environments despite the prevalence of musculoskeletal injuries caused by abuse. The open-access study, featured in *JBJS Open Access*, is based on a survey of over 11,000 patients who reported violence, emphasizing the vital yet neglected function of orthopedic clinics in recognizing signs of harm.
**The Crucial Last Contact Point**
This oversight is particularly significant since, for many patients, the orthopedic team represents the only medical contact. Remarkably, more than three-quarters of those ultimately referred through orthopedics had not consulted any other specialist in the six months leading up to their disclosure. If the surgeon failed to notice the signs, no one would.
This finding disrupts established beliefs about where abuse manifests within medical care. Notably, over half of the referrals from orthopedics arose not from trauma emergencies but from standard, elective operations—such as joint replacements, spine surgeries, and chronic pain management. These were not urgent cases but prearranged visits where someone on the medical team detected discrepancies in injury patterns or patient behavior.
The study revealed that nurses, residents, and advanced practice providers were the main identifiers of these instances, not the attending surgeons. Social workers facilitated the referrals, although initial disclosures seldom occurred directly with them. This highlights the necessity for the entire care team’s involvement, exposing a systemic void in utilizing available chances to uncover abuse. The researchers pointed out that orthopedic clinicians, through their extended interactions during follow-ups and rehabilitation, are instinctively situated to notice suspicious dynamics that may escape attention in a brief emergency room scenario.
**Transformational Power of Awareness**
Assistant Professor Ophelie Lavoie-Gagne, a co-author of the study, stresses, “This study highlights the pressing need for tools that enable us to make prompt, life-saving referrals. Early identification of risk could reduce suffering and potentially save lives.” The emergence of advanced artificial intelligence models shows promise in supporting these initiatives, capable of scanning imaging and clinical notes to highlight subtle signs of abuse such as fractures inconsistent with reported mechanisms and recurring incidents termed as “accidents.”
Crucially, when orthopedic teams successfully identify abuse, interventions significantly alleviated burdens for victims. Patients engaged in safety planning and customized treatment to align with their home situations. Many continued to connect with support programs over long periods, illustrating genuinely necessary interventions rather than mere overreactions.
The research does not propose turning orthopedic surgeons into social workers or adding yet another layer of screening checklists to their already packed agendas. Instead, it contends that these clinicians, equipped with extensive knowledge of injury mechanisms and bolstered by trusted relationships, are uniquely positioned to observe signs that others might overlook. A consultation for a hip replacement or a fracture follow-up could indeed represent the sole opportunity to view a patient’s life with the trained perspective needed to discern inconsistent injury patterns.
For patients whose consistent healthcare engagement revolves around managing chronic pain or repairing fractured bones, these orthopedic appointments may signify more than mere medical attention—they could be the crucial moment where invisibility transforms into the potential for assistance.
[Read the complete study in *JBJS Open Access*](https://doi.org/10.2106/JBJS.OA.25.00148)
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