An international study has found that four out of ten women who go to the hospital with a bone fracture or dislocation have suffered gender violence at some period in their lives. The results published in The Journal of Bone & Joint Surgery prove, once again, the prevalence of this kind of violence in society. This study was conducted concurrently in six hospitals in Canada, the Netherlands, Finland, and Spain.

The requirements to participate in the study were to be a woman of legal age with a recent traumatic injury (fracture or dislocation), and to be able to respond self-sufficiently to the investigators' questions. A total of 250 participants were selected and given a questionnaire on gender violence that was repeated at each visit. Each patient was evaluated for one year divided into an initial appointment and four follow-up assessments. Twelve professionals (PRAISE-2 Investigators) from the Orthopedic Surgery and Traumatology Service of the Traumatology, Rehabilitation, and Burns Hospital collaborated under the leadership of Dr. Maria Villar, internal medicine consultant at Vall d'Hebron Hospital and researcher of the Reconstructive Surgery of the Locomotor System group of Vall d'Hebron Research Institute (VHIR) and the coordination of Yaiza Garcia, researcher of the same group.

79% of the women who reported having suffered some type of gender-based violence (physical, emotional, or sexual) did so during the first visit, while the remaining 21% did so at later follow-ups. The researchers present two hypotheses, which are not mutually exclusive, for this second group. The first is that the situation of vulnerability and dependency experienced by women with orthopedic injuries increases their risk of experiencing intimate partner violence. Several studies have shown that women with reduced mobility have higher rates of abuse and a greater incidence has also been documented during challenging health periods such as pregnancy and postpartum. The second hypothesis is that during monitoring, a bond of trust is established between the patient and the health professionals that enables the former to reveal previously unreported cases of abuse.

In both cases it is essential that the professionals who attend them are trained and have a clear protocol for identifying these cases. "Traumatology is a key area," explains Yaiza Garcia, who considers that the chances of healthcare professionals encountering women who have suffered any kind of gender violence are very high. "Musculoskeletal injuries are the second most common injuries resulting from gender-based violence".

Lower health-related quality of life

Another parameter analyzed by the researchers is whether having suffered gender-based violence, even if this was not the cause of the injury, can lead to increased difficulty in recovery. The data obtained, although preliminary, suggest that women with a history of gender violence have a lower health-related quality of life and greater difficulty in recovering their pre-injury functional levels despite the fact that they did not show a higher rate of complications. These results did not vary according to the time that passed since the aggression; they were similar whether they stated that violence was the cause of the injury, had suffered aggression during the last 12 months, or stated that it had been years since the last incident. The results are not clinically conclusive, but they open the door to further research on the long-term health implications for victims of gender-based violence.

In 2020, Vall d'Hebron launched a transversal protocol on gender-based violence that coordinates all the hospital's professionals in order to provide integral assistance to women who are victims of gender-based violence. The protocol is designed to be activated during a visit caused by either physical or psychological aggression. This new study shows that even if the violence is not the direct cause of the visit, professionals must assess the possible existence of a history of gender violence that affects the patient's recovery and quality of life. At the same time, the consultation must be considered as an optimum place to detect concealed cases and to provide early and needed assistance to women in situations of gender-based violence. During this study, for example, when a woman reported a history of gender violence in our center, she was offered support and assistance, putting her in contact with all the services and resources available at Vall d'Hebron.