OBJECTIVE: 1) Establish current opinion from medico-legal sources based upon the following questions: Does the surgeon owe a duty of care to advise an x-ray for nasal fracture secondary to assault? Does a fracture demonstrated by x-ray result in the ability of the prosecution to establish a greater degree of harm against the victim? 2) Identify patients who underwent manipulation under anesthetic (MUA) of nasal fracture secondary to assault and investigate their legal outcomes. METHOD: A number of relevant medical and legal sources were contacted. The above questions were posed and advice sought. In this retrospective study, all adult patients who underwent MUA of a nasal fracture over a 1-year period (1st January 2007-1st January 2008) were contacted. If reported as a non-accidental fracture, further questions were asked; whether a facial x-ray was performed pre-operatively; did the patient proceed to press charges; if so, the outcome of the prosecution and court hearing. RESULTS: 97 patients underwent MUA of nasal fracture in the unit over the year. Information was available for 68 patients, non-accidental injury accounted for 26 cases (38%). Six patients within this group proceeded to press charges. The legal outcome of these patients is discussed. Literature review highlights controversy regarding the value of imaging but little is published giving guidance in cases of non-accidental nasal fractures where legal action is likely to proceed. CONCLUSION:We present an up-to-date review of medical and legal perspectives and the legal outcome of patients presenting with non-accidental nasal fractures managed in our department.

exact test while level of significance was set at pϽ0.05. RESULTS: Out of the 37 confirmed cases of LF, 5(13.5%) and none (0%) of the control developed Early-onset SNHL (pϭ0.03). Forty percent of the cases studied had negative IgM. The audiograms ranged from 65-85dB and the speech discrimination 20-40%. Overall case fatality rate was 27%, and for Early-SNHL cases 60% (pϾ0.05). CONCLUSION: The incidence of sensorineural hearing loss in Lassa fever infection is about 13.5% and could be a reflection of a worse disease process. There is possibility of direct viral invasion aside immunological reaction as a causative mechanism.

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