32 year old punched in the face. What's the diagnosis?

32 year old punched in the face. What’s the diagnosis?

Nasal bone lateral view

Soft tissue lateral view of the nasal bone.

Unnecessary radiation exposure

Fractured Nasal bone. However there was no need to X-ray as it is only managed by clinical presentation re deviation. Review in a week -10 days when swelling has subsided for correction by ENT. Immediate referral if there is a septal haematoma to prevent AVN of the nasal bone.

what you say is certainly true, but being an assault injury (at least in Italy) the x-ray is essential to establish a correct prognosis (legally speaking)…but clinically irrelevant

as a Emergency Nurse Practitioner (now retired) I had to write many police statements on assault patients, and in this instance I would say X-rays are no longer required in nasal bone fractures as it is unnecessary radiation and does not affect clinical management. Clinical presentation re deformity requires ENT referral only. I never had any problems, however I understand what you are saying. Looking at this X-ray there was no need to include so much of the face on the lateral view.

that’s quiet interesting . But don’t you think the X-ray was necessary considering there might be other fractures if let’s say he got punched twice or the maxilla might get fractured also ?

then the patient needed facial bones views. Lateral face doesn’t tell you which side is fractured and is of no use in trauma

they wanted only the nasal bone. However if they had injuries suggestive of zygoma # , orbital floor # ( blow out#), mandibular/ maxillary #’s then the appropriate views should be requested. The lateral view for this case scenario is far too excessive for nasal bone ( which isn’t necessary) and of no use for other facial bone #’s v