Int J Emerg Med (2010) 3:45–47 outcomes. There is no evidence that lack of access to advanced imaging impacts adversely on clinical outcome. The reasons for the persistent use of plaster immobilisa- tion in Australian ED is unclear. The weight of evidence would suggest that this is over-treatment and that a simple bandage is sufficient. The likely explanations are habit and fear of medicolegal risk. This study has some limitations that should be consid- ered when interpreting the results. As this was a survey, the management strategy reported may not be that actually used. Only one clinician per ED was surveyed. This would not identify within-ED variations in practice. Conclusion The traditional approach to management of possible occult scaphoid fracture of immobilisation with re-X-ray at 7– 10 days remains the most commonly used in Australasia, despite evidence that this is probably over-treatment with significant consequences for patients. The place of ad- vanced imaging for investigation of potential scaphoid fractures requires further research. Conflicts of interest None. 47 References 1. McRae R (1981) Practical fracture treatment. Churchill Living- stone, New York 2. Best BETS. Immobilisation of suspected scaphoid fractures. 2000. http://www.bestbets.org/bets/bet.php?id=97. Accessed Oct 2008 3. Pillai A, Jain M (2005) Management of clinical fractures of the scaphoid: results of an audit and literature review. Eur J Emerg Med 12:47–51 4. Mittal RL, Dargan SK (1989) Occult scaphoid fracture: a diagnostic enigma. J Orthop Traumatol 3:306–308 5. Duncan DS, Thurston AJ (1985) Clinical fracture of the carpal scaphoid–an illusionary diagnosis. J Hand Surg [Br] 10:375–376 6. Jacobsen S, Hassani G, Hansen D et al (1995) Suspected scaphoid fractures. Can we avoid overkill? Acta Orthop Belg 61:74–78 7. Sjolin SU, Andersen JC (1988) Clinical fracture of the carpal scaphoid–supportive bandage or plaster cast immobilization? J Hand Surg [Br] 13:75–76 8. McLaughlin H, Parkes JC (1969) Fracture of the carpal navicular (scaphoid) bone: gradations in therapy based upon pathology. J Trauma 9:311–319 9. Zarnett R, Martin C, Barrington TW et al (1991) The natural history of suspected scaphoid fractures. Can J Surg 34:334– 337 10. Tai CC, Ramachandran M, McDermott ID et al (2005) Manage- ment of suspected scaphoid fractures in accident and emergency departments-time for new guidelines. Ann R Coll Surg Engl 87:353–357 11. Blum A, Sauer B, Detreille R et al (2007) The diagnosis of recent scaphoid fractures: review of the literature. J Radiol 88:741–759