Intimate partner violence: an underappreciated etiology of orbital floor fractures.
OBJECTIVE
To evaluate the prevalence of intimate partner violence (IPV) in a large population of female orbital floor fracture patients and provide recommendations on effectively identifying and referring IPV survivors.


METHODS
Retrospective review of facial fracture patients examined at the University of Iowa Hospitals and Clinics between January 1995 and April 2013. International Classification of Diseases, Ninth Revision, codes and medical record review were used to determine the prevalence of IPV victimization and clinical outcomes.


RESULTS
A total of 1,354 women and 4,296 men sustained facial fractures. Of these, 405 women and 1,246 men sustained orbital floor fractures. Leading mechanisms of orbital floor fractures in women were motor vehicle collisions (29.9%) and falls (24.7%). Twenty percent had no etiology documented. Intimate partner violence-associated assault was the third leading documented cause of orbital floor fractures in women (7.6%) followed by non-IPV-associated assault (7.2%). Among women with orbital floor fractures due to assault, leading patterns of injury included the following: isolated orbital floor fractures (38.7%, 12/31 in IPV patients; 55.2%, 16/29 in non-IPV patients), zygomaticomaxillary complex fractures (35.5%, 11/31 in IPV patients; 17.2%, 5/29 in non-IPV patients), and orbital floor plus medial wall fractures (16.1%, 5/31 in IPV patients; 24.1%, 7/29 in non-IPV patients). Involvement of ancillary services was documented in 20.0% (7 law enforcement and 5 social service agencies, 12/60) of assault-related orbital floor fracture cases. Ascertainment of patient safety was documented in 1.7% (1/60) of these cases.


CONCLUSIONS
Ophthalmologists treating orbital floor fracture patients should maintain a high index of suspicion for IPV and screen accordingly. Following IPV disclosure, patient safety should be assessed and referral provided.
*Carver College of Medicine, University of Iowa, Iowa City, Iowa; †School of Social Work, University of Minnesota, St. Paul, Minnesota; ‡Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts; §Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa; and ‖Department of Ophthalmology, Cincinnati Eye Institute, Cincinnati, Ohio, U.S.A.
Thomas J
TJ
Clark
Lynette M
LM
Renner
Rachel K
RK
Sobel
Keith D
KD
Carter
Jeffrey A
JA
Nerad
Richard C
RC
Allen
Erin M
EM
Shriver
D000293:Adolescent; D000328:Adult; D005151:Facial Injuries / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009917:Orbital Fractures / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery; D015995:Prevalence; D012189:Retrospective Studies; D013179:Spouse Abuse / Q000706:statistics & numerical data*; D017741:Survivors; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult