Dr. Luciana Marzella explains how to identify the signs of domestic violence through hand trauma. When the body denies the lies
Our body knows how to communicate on its own. Every action we perform leaves marks: on the skin, on the bones, in the bruises that always repeat in the same place. He knows it well Doctor Luciana Marzella, head of the Hand Traumatology and Microsurgery Service of the IRCCS Galeazzi-Sant’Ambrogio Hospital of Milan, who will be among the protagonists of the conference “Domestic violence and discrimination: a reality to know to fight it”, scheduled for Friday 8 May 2026, from 9 am to 12.50 pm, at the IRCCS Galeazzi-Sant’Ambrogio Hospital in Milan (Via Cristina Belgioioso 173). An event that is more necessary than ever: according to ISTAT data, in 2025, 6.4 million women between the ages of 16 and 75 were victims of violence in Italy, a number destined to grow if we also consider violence against minors and the elderly. The conference, chaired by Dr. Marzella herself, is divided into three thematic sessions. The first is dedicated to domestic violence against women: we will talk about clinical indicators, the management process activated at Galeazzi, the role of social media and the media. The second session addresses a more silent but equally real form of violence: gender discrimination in access to top roles in healthcare. Finally, the third focuses on domestic violence against children and the elderly, including that in nursing homes. The speakers include the Minister for Family, Birth and Equal Opportunities Eugenia Maria Roccella, the Welfare Councilor of the Lombardy Region Guido Bertolaso and numerous specialists in hand surgery, orthopedics and preventive medicine. Registration is free and open to all healthcare professionals and citizens.
A daily bulletin that can no longer be ignored
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“It’s a pretty hot topic,” the doctor begins Marzella. “We now have a sort of daily bulletin of domestic violence, especially against women, but also against children and the elderly.” A reality that it has chosen to face with the tools that belong to it: anatomical knowledge and a clinical gaze capable of reading what words hide. “Together with other colleagues I approached this topic and developed some systems that allow doctors to detect minor traumaswhat can be a possible domestic violence”.
The lies that bones deny
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Women who arrive at the emergency room, sometimes accompanied by their husbands, with traumas described as accidental falls, fingers stuck in a drawer, missed steps. Apparently plausible stories, but which don’t add up to an expert eye: “They arrive at the clinic saying that they fell down the stairs or that they accidentally hurt themselves, but they have traumas that are so specific and so different which, for me as an expert in hand surgery, I realize that these are absolutely not the traumas they say.” The explanation is anatomical, precise, difficult to dispute. When a woman is attacked, her first instinct is to protect her face by putting her hands forward. And that’s where the truth is written: “The hands very often have bruises and fracturesespecially on the outermost portion: I’m talking about the little finger and the external portion of the wrist, which is called the ulna. They are isolated fractures that have particular characteristics that make us think of violence.” The numbers, in this case, speak for themselves. “An isolated fracture of the ulna is very rarely due to accidental trauma, because usually when one falls the radius breaks more frequently. So if a patient says ‘I fell down the stairs’, he or she has told a lie, because that type of trauma cannot possibly be due to that.” Even more eloquent is the story of the little finger: “Dislocations or fractures of the proximal phalanx of the little finger are produced only by a torsion mechanism. I usually see fractures of this kind, for example, in a person who is walking a dog on a leash: the leash twists around his finger and twists it, this is plausible. But if instead a lady comes to me with a finger twisted like this, who tells me ‘I fell down the stairs’, this doesn’t add up to me. I start asking questions and in the end I understand that it is violence.”
Anamnesis as a listening tool
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But the body also speaks through what cannot be seen: the silences, the glances, the pauses of each of us. Because of this the collection of clinical history becomes an equally powerful tool. “The medical history is fundamental. I spend some time talking to patients also to understand their reactions. One of the things I notice very often is that when I ask ‘what happened ma’am, how did you get hurt?’, they immediately look at their partner. It’s an attitude almost as if they’re asking for permission to answer.” And then there’s the tendency to minimize painthat unnatural way of belittling a suffering that should instead scream. “When someone gets hurt, they complain, there’s little that can be done. These women, on the other hand, tend to minimize it: they say ‘it doesn’t hurt, there’s no need for surgery’, they try to avoid anything that could lead to further exploration of the trauma.”
From diagnosis to way out
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Once suspicion has arisen, the path does not stop at the diagnosis. “We try to keep them in hospital. This allows the patient to have a little more confidence with the doctor, but also to activate a system of social workers who can talk to her and try to understand if she is able to confide in her.” And here emerges a clear awareness gained in the field: “You have to arrive at the report prepared, because when a patient reports before having a way out or adequate assistance, very often she finds herself in trouble. And we know how it ends.”
Domestic violence: Time saves
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In a frenetically paced healthcare system, Marzella forcefully claims the value of humanity in the doctor-patient relationship. “The human aspect is fundamental and I have made this the basis of my professional work. When you have a patient in front of you, you need to dedicate the necessary time to ask the few questions that can make us think about the type of trauma. And if there is a suspicion that there may be violence, spend two minutes more to create a relationship of greater trustthen make sure to get him back for more frequent checks, precisely to ensure that a more constant and safer relationship is created, which becomes a sort of lifeline.” A message also addressed to colleagues: “Humanize the patient and not consider them all the same. I have a very hectic activity, but my patients know that they can count on me, they can talk.”
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