Orthopedic Reflections on Violence and Child Abuse

Behavioral disturbances and violence are becoming increasingly common worldwide. Violence due to abuse reflects the defenselessness of the patient. Abuse may be physical, psychological, sexual, or simply due to negligence or connivance. Although an increasing awareness of abuse across the world is encouraging, it must be borne in mind that the data gathered so far, and detected cases, are only the tip of the iceberg. Possible cases of abuse should always be considered by physicians when examining patients, and attention should be paid to the patient's history and age, along with the location, number, and patterns of lesions and the time that has passed since the injuries occurred. Although there is a general opinion that “there is no specific fracture for abuse” [1-4], we believe that some lesions ought to alert physicians to cases of abuse. For an exact diagnosis, we recommend that a detailed history should be taken, a detailed examination performed, and imaging modalities be conducted and properly evaluated. In a study conducted in youth by Koç et al., it was shown that the average rate of physical abuse during childhood in our country was 20.5% [5]. However, we are conscious that there is inadequate awareness of such abuse. Our aim was to gather data, discuss the subject of abuse from an orthopedic perspective, and increase awareness of child abuse. Abuse It can be difficult for patients who have been exposed to violence to express themselves clearly and, as a result, incidents of violence and abuse tend to be concealed. Because of this, abuse is more likely to be misdiagnosed by physicians. In a previous study, it was suggested that 20% of cases are misdiagnosed [6]. In another study, it was shown that half of all abused children underwent examination by an orthopedic specialist on at least one occasion [7]. Therefore, physicians need to be alert to possible abuse when examining children, particularly those under three years of age [3,8-10]. Moreover, 50% of abuse patients who are unprotected are likely to be exposed to abuse again, and 5–10% of those die due to recurrent abuse [7,10-12]. In hospitals, orthopedic specialists play a major role in identifying physical abuse victims due to their involvement with trauma cases. However, identifying abuse can prove difficult. According to Oral et al., 42% of abuse-related cases are impossible to detect [10]. Difficulty in detecting abuse may occur for various reasons. First, physicians working in emergency departments generally work very hard. While they pay close attention to caring for their patients, they do not tend to think like police officers and generally do not consider the answers to questions such as “why” and “how”. Second, physicians are dependent on the history that a family provides. This said, awareness and experience can resolve this problem. Studies have demonstrated that pediatric orthopedists are more successful at identifying and reporting abuse cases than general orthopedists [10,13]. Additionally, it is understood that Orthopedic Reflections on Violence and Child Abuse