SUMMARYTenderness in the anatomical snuff box (ASB) has long been accepted as an indicator of a possible scaphoid fracture. The longitudinal axis of the scaphoid lies in an anteroposterior plane, perpendicular to the remainder of the carpal bones, in the radially deviated wrist. The scaphoid tubercle can therefore be easily and accurately palpated on the palmar aspect of the radially deviated wrist.This study was devised to determine if tenderness over the scaphoid tubercle (ST) was superior to ASB tenderness in identifying definite fractures.Over a 10-month period 246 patients were seen who were suspected of having a scaphoid injury. Thirty (12%) were eventually proven to have definite fracture. Tenderness in the ASB had a sensitivity rate of 90% (95% confidence limits 80-100%) and specificity of 40% (33-47%) as an indicator of a definite fracture. ST tenderness had a sensitivity of 87% (75-99%) and specificity of 57% (50-64%). There is therefore no significant difference in the sensitivity between ASB and ST tenderness but ST tenderness is significantly more specific. However, the presence of either ASB or ST tenderness should be used in order to identify all fractures. Patients with neither ASB nor ST tenderness require symptomatic treatment only.

SUMMARYElbow injuries are commonly seen in accident departments. Patients with possible bony injuries to the elbow were assessed to see if inability to fully extend the elbow was a good indicator of bony injury and hence the need for X-ray.The sensitivity of this test was 90-7% (95% confidence limits 80-7-100-7) and the specificity 69-5% (95% confidence limits 60.3-78.7). Use of this simple test would reduce both radiography costs and unnecessary exposure to radiation.

SUMMARYA prospective study was carried out during the month of November, 1990 in the A&E Department, St John's Hospital, Livingston in order to assess the extended role of the A&E nurse and their ability to request X-rays prior to patients being seen by a doctor.A total of 579 randomly selected patients were triaged by A&E Department nurses. Almost 3/4 of these patients were X-rayed at the request of the triage nurse. Less than 7% of these X-rays were considered to have been unnecessary by the doctor who subsequently managed the patient. Of those patients who had an X-ray after seeing a doctor, more than 90% fell within the X-ray triage criteria but had not had an X-ray requested by the triage nurse.Overall, nurses were shown to request X-rays correctly and efficiently with the result that patients had to spend less time in the A&E Department.

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