Orthopaedic surgeons are being urged to become more vigilant to signs of family violence among their patients in hospital emergency rooms and their offices.

Many abuse victims come to hospital emergency rooms complaining of musculoskeletal problems and othopaedic surgeons often are the first physicians to treat and talk to them about their injuries.

As many as one out of four women using emergency departments are victims of abuse. In 1999, there were 826,000 cases of documented child abuse. The National Center on Elder Abuse estimated that in 1996 there were 1 to 2 million cases of elder abuse. Many other victims of family violence are treated in physicians' offices.

Clues to identifying abuse victims are patients with a history of multiple emergency room visits for injuries, poor eye contact, evasive answers and inconsistent explanations of injuries and bruises at varying stages of recovery. Children with multiple fractures, especially if they are under one years old, should be carefully evaluated because they are vulnerable and cannot fully articulate the reason for their injury.

Every state has a law requiring physicians to report suspected child abuse cases. However, some states do not mandate physicians to report suspected cases of elder and domestic abuse.

Family violence is a public health crisis. Physicians have a duty to get involved and help the victims. Many hospitals have policies and protocols for physicians to follow when identifying and treating victims of abuse.

The American Academy of Orthopaedic Surgeons has joined the American Medical Association in its Physicians Campaign Against Family Violence. Orthopaedic surgeons are encouraged to become involved with national and state family violence coalitions. A resource guide is available on the Academy's Web site listing national and state agencies that help victims of family violence.