by Jowan Penn-Barwell 
Consultant Orthopaedic Trauma Surgeon, Oxford University Hospitals NHS Foundation Trust

Published 08 April 2020

Before we talk about IPV during these times of social isolation, it is worth understanding the normal scale of the problem in UK society. Over the last ten years an average of 82 women a year are killed by a partner or ex-partner1. Murder is normally the final act after a series of assaults and a pattern of controlling and coercive behaviour2.

The PRAISE study3 looked at fracture clinics in Canada, the USA, the Netherlands, Denmark, and India. It found that 1 in 6 female patients had experienced IPV in the last year and 2% were attending with as a direct result of IPV. We are seeing the victims of IPV in our clinics every week, we just don’t realise it.

It has been speculated that the COVID-19 crisis and its associated emotional stress, financial pressure and prolonged domestic proximity will lead to an increase in IPV.

What can we do?

Firstly, we need to make ourselves aware of the services in our region for IPV victims and survivors. Hospital safeguarding teams should be able to provide advice and information.

Secondly, we need to be able to identify IPV victims. In normal circumstances this can be challenging as the perpetrators are often closely attentive during medical consultations, and act as a barrier to disclosure. However, this is where the current unique circumstances present an opportunity as most fracture clinics are currently insisting on adult patients attending unaccompanied.

Another opportunity for intervening when patients are alone is during imaging: patients are unaccompanied during their X-rays. Posters and leaflets highlighting services available can be displayed. Some departments go further and screen for IPV in X-ray: affected individuals are then called back into consultation rooms alone.

Finally, how can you identify IPV victims and survivors? This is clearly a difficult subject to discuss and individuals may feel a deep sense of shame and guilt as well as fear. A good opening line is:

“I’ve been doing this job for a while, and I know that not all injuries are accidents.”

This can be followed up with screening questions:

“In your normal life at school/home/college with friends, do you feel safe?”
“Has anyone forced you to do anything you did not want to do?”
“Do you feel safe in your relationship?”

If someone does disclose that they have experienced IPV then listen without judgement and identify whether there are any children who are at risk.

Unlike many of the problems our patients have, this is one that isn’t in our abilities to fix directly. But if we can identify IPV victims and survivors in our clinics and help them speak to the safeguarding team discretely, we might be helping with the first step to break the cycle of violence and abuse.


  1. Great Britain. Office for National Statistics. Homicide in England and Wales: Year ending March 2019.
  2. Kyriacou DN, Anglin D, Taliaferro E, Stone S, Tubb T, Linden JA, et al. Risk factors for injury to women from domestic violence. N Engl J Med. 1999;341(25):1892-8.
  3. PRAISE Investigators: Sprague S, Bhandari M, Della Rocca GJ, Goslings JC, Poolman RW, et al. Prevalence of abuse and intimate partner violence surgical evaluation (PRAISE) in orthopaedic fracture clinics: a multinational prevalence study. Lancet. 2013;382(9895):866-76.