Intimate partner violence

Last revised by Daniel J Bell on 3 Aug 2022

Intimate partner violence is violence between current or former partners affecting predominantly women. It can take many forms including sexual, emotional or physical violence.

Medical imaging staff have a unique role in identifying intimate partner violence, equipped with a thorough knowledge of both the appearance of defensive injury patterns and the mechanisms that lead to them are vital to understanding an indefinite clinical history.

Intimate partner violence is limited violence between intimate partners. It is different, conceptually, from domestic violence whereby the abuse is not exclusive to a particular party and can include any members of a household 1.

Regarding the physical abuse of children, the terms suspected physical abuse (SPA) or inflicted injury of children are preferred 2.

According to a World Health Organization report from 2021 3, up to 30% of females globally, who have been in a relationship, have experienced intimate partner violence.
A 2018 report from the Centers for Disease Control and Prevention in the US using data from 2015 4, found that nearly 1 in 10 men suffered from intimate partner violence in the United States.

Clinical presentation is hard to quantify in this setting. Sadly, victims will often present to the emergency department with concerns that are not directly related to intimate partner violence 5 However, and there are several red flags to be aware of:

  • injury patterns that do not match the clinical details 
  • repeated presentations to the emergency department for minor issues 
  • reproductive health conditions
  • mental health concerns

If a diagnosis of intimate partner violence is made, the radiologist has at their disposal the patient's history of imaging exams. Review of past exams is recommended to locate imaging patterns that could be perceived as specific to physical abuse and assess for chronic injuries that could have otherwise been overlooked 5. Much like the approach of suspected physical abuse of children, the presence of more than one finding at different stages of healing can be suggestive of intimate partner violence 5

Although there are no pathognomonic features of intimate partner violence, it is worth noting injury patterns commonly observed in these settings and correlating that to clinical history.

Very common (up to 88% in one study 6) in victims, most commonly a result of a punch or blunt object most patients suffering from soft tissue swelling/contusions. Specific injuries include:

Most commonly, victims will injure themselves in defense, injuring the hand, wrist or forearm. These are often concealed by mechanisms such as falling, sport-related or motor vehicle accident. It is essential to look for features of a direct blow, rather than the described mechanism. 

  • phalangeal or metacarpal fractures
    • most common defensive injury 
    • tend to be non-displaced and linear fractures
  • isolated ulnar fracture 
    • defensive injury, a.k.a. a nightstick fracture, when the arm is raised to block
    • unless a fall is onto a corner, such as a stair, very unlikely to occur unless it is a direct blow 

Injuries of the head and neck often mean the patient has suffered excessive violence. Victims of intimate partner violence can present with:

Posterior injuries to the chest and shoulder are often the result of sudden force to the posterior region such as being pushed into a wall or to the ground. Features include: 

A sound understanding of these injuries, how they occur and how they present is only half the battle. Intimate partner violence is difficult to 'diagnose' and often will go undetected for many years. Clinical details, as given by the patient, are essential and should be carefully documented. If one is unsure about a patient's clinical details and/or examination, contact the referring clinician and/or consider asking the radiographer if they have anything to add to the story. 

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Cases and figures

  • Case 1: orbital blow-out fracture
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  • Case 2: depressed frontal sinus fracture
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  • Case 3: isolated ulna shaft fracture
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  • Case 4: mandibular fracture
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