Plain film x-rays should not be ordered as part of the management of nasal fractures. The decision to reduce a nasal fracture depends on numerous factors including patient preference, external deformity, and breathing difficulty, none of which are effectively assessed by an x-ray. They have a very low sensitivity and specificity, with 63.3% and 55.7% respectively. As such, plain x-rays are unable to accurately diagnose occult fractures. Despite being commonly ordered for medicolegal documentation of nasal fractures, the poor sensitivity and specificity brings into question their value in medicolegal proceedings. In studied cohorts, no unsuspected facial fractures were identified solely on nasal x-rays, and no negative effects on management occurred when an institution instituted a “no nasal x-ray policy”. Overall, nasal x-rays do not contribute to diagnosis, documentation, or management decisions, and should not be ordered.
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