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SUMMARYA search of accident and emergency department records showed that 61% of 85 children registered as being physically or sexually abused by the Department of Community Paediatrics at St James's University Hospital, Leeds, England, were found to have visited the accident and emergency department an average of 2-9 times before the diagnosis was made. Fifty-two per cent of the attendances were because of problems other than injuries. Staff of accident and emergency departments should be aware that abused children present with medical diagnoses as well as trauma. Increased awareness may result in earlier diagnosis of abuse in some of these children.

SUMMARYHand injuries account for 10-20% of an Accident & Emergency department's workload. Early recognition of serious injury is vital to ensure appropriate management. This is only possible with a good working knowledge of hand anatomy.Forty consecutive A&E senior house officers (SHOs) were assessed on their knowledge of basic hand anatomy. The results are discussed as are the implications for undergraduate and post-graduate training.

SUMMARYWe present a case of dislocations of the carpometacarpal joints without associated fractures. Although carpometacarpal injuries are relatively uncommon, it is rare for multiple carpometacarpal dislocations to occur without associated fractures. The injury is difficult to diagnose because of swelling of the hand. A lateral radiograph of the wrist has been found to be mandatory to its precise diagnosis if suspected.In the case presented here early diagnosis and closed manipulation in the accident and emergency (A&E) department resulted in a good outcome.Key words: carpometacarpal dislocations, diagnosis, investigation, management, radiographs CASE REPORT cast with the wrist in a neutral position was applied. A check radiograph showed a satisfactory reduction.The patient was reviewed after 1 week when he was comfortable in his cast. A further 2 weeks later he returned for follow-up having removed his own cast. He had a full range of painfree movements in his hand and wrist. A 20-year-old construction worker presented to the A&E department complaining of pain in his right hand and inability to move his fingers. He stated that he had punched a wall in anger. He admitted to having consumed alcohol. DISCUSSIONOn examination there was swelling on the dorsum of his right hand. Active movements were not possible due to pain but limited passive movement of the fingers were present. There was no neurovascular deficit in the fingers. A provisional diagnosis of fracture of the metacarpals was made. The routine postero-anterior and oblique radiograph of the hand did not show any fracture but made us suspicious of an injury at the carpometacarpal joints (Fig. 1). A lateral radiograph of the wrist was requested.The lateral radiograph of the wrist clearly demonstrated carpometacarpal dislocations of the index, middle, ring and little fingers but no fractures were seen (Fig. 2). The dislocations were easily reduced by linear traction of the fingers under axillary nerve block. The reductions were stable. A below elbow

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