A new study suggests more of the women who go to hospital with broken bones have been the victims of domestic violence than previously thought, yet few are being asked whether they’re being abused.

The study comes from researchers at McMaster University in Hamilton, Ont., who looked at close to 3,000 women who went to 12 fracture clinics in five countries: Canada, the United States, the Netherlands, Denmark, and India.

All the women involved in the study agreed to anonymously answer questionnaires about abuse.

One in three of the women revealed they had experienced physical abuse at the hands of their partners at some point during their lives. One in 6 admitted they had been assaulted within the past 12 months.

What’s more, one in 50 disclosed they had arrived at the clinic as a direct result of domestic abuse.

The researchers also found that of those with the worst broken bones and dislocated joints, two-thirds were linked to domestic violence.

“What surprised us the most is the severity of the physical violence was much higher than we expected,” says Dr. Mohit Bhandari, an orthopaedic surgeon at Hamilton Health Sciences Centre and one of the study’s researchers.

The researchers were also struck by the fact that only a handful of the women said a health-care professional had ever asked them whether they were being abused.

Red flags for Healthcare workers treating women with injuries:

  • Husband or partner who “hovers” and who answers questions for the injured woman
  • Women who seem hesitant or reluctant to answer
  • Injuries that don’t fit the explanation

The study authors say their findings are a call to doctors and staff at fracture clinics to look beyond the X-rays, so they can ask whether domestic violence might be the real reason behind the broken bones they treat.

They say staff in such clinics are well-positioned to spot abused women, since they often develop long-term interactions with patients during repeat visits for follow-ups and surgical procedures.

“Nisha” is one of the women who says doctors never asked about her abuse. Virtually every week, she ended up in hospital, sometimes with injuries. Other times, it was with the symptoms of panic attacks.

Nisha -- who doesn’t want her full name used -- says she endured years of physical and emotional abuse that started a week after she arrived in Canada from India to join her husband. He would push and hit her, laid down strict rules about when she could come and go, and made her a virtual prisoner in her home, she says.

“I was always on the edge because his temper and outbursts…what he would break. When he didn’t like something, he would throw the plates, break something,” she tells CTV News.

Not once during all those hospital visits, was Nisha ever asked about what caused her anxiety or her injuries, she says. “Never, ever, ever. My family doctor knew I had been going to emergency every week for two years. He would tell me to go home. He never asked.”

Bhandari suspects that doctors at fracture clinics haven’t been asking women about whether there might be violence at home because they were not aware of the problem or underestimated the extent of it.

He says one survey suggested doctors assumed that about 1 per cent of the fractures they saw each year in clinics were the result of domestic violence, when it appears from this study that the numbers are much higher.

Bhandari also says orthopedic surgeons are simply not trained in social issues, such as domestic abuse.

“They focus on treating factures, and they become so narrow in the focus that we lose sight of this hugely important issue,” he says.

Clare Freeman, who helps run a home for abused women in Hamilton called Interval House, says doctors have a role to play in addressing domestic abuse.

“I think in health care, there’s been this idea of ‘don’t ask.’ Because if we open it, then what do we do?’” she says.

She’s hoping this study will open the eyes of more doctors.

“So that they know it’s more than a bone, and that we need to figure out why. If we want to heal the bone well, the circumstances around that person do matter.”

With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip