The word “ladette”, defined by the Oxford Dictionary as “a young woman who behaves in a boisterous, assertive or crude manner and engages in heavy drinking sessions”, and the related culture of alcohol-fuelled anti-social behaviour has been quoted as being on the rise in the UK.

A retrospective study in three district hospitals has shown an 825 per cent increase in females aged 13–20 years attending for nasal fractures from 2002 to 2009.

The study supports the notion that violence amongst young women is increasing with a significant proportion of injuries being caused by non-domestic violence.

A retrospective study was performed in three district UK hospitals (Luton and Dunstable Hospital, The Lister Hospital and the Royal United Bath Hospital), serving a catchment population of approximately 1.5 million.

Operating theatre data for all females who attended hospital for manipulation of a nasal fracture under anaesthesia between January 2002 and December 2009 were retrieved. Case notes of all female patients attending Luton and Dunstable Hospital for assessment of a nasal fracture over a five-year period, from January 2004 to December 2009, were also reviewed, regardless of whether the patients underwent manipulation of their fracture under anaesthesia or not.

From 2002 to 2009, the collected data demonstrated an increase in the number of women presenting with nasal fractures, in all age groups. The greatest increase in incidence was seen in the 13–20 year age group. There were only 4 girls who underwent manipulation under anaesthesia across the 3 sites in 2002, whereas the respective number in 2009 had risen to 33, representing an 825 per cent increase. By comparison, the incidence in males had only risen from 47 to 102 during the same time period, a 217 per cent increase.

Accidental injury was the most common cause of nasal fracture. Falls and occupational accidents seem to play an increasing role in the epidemiology of nasal injuries in women, as they become more exposed to the respective risk factors in a society that considers them stronger and more independent compared with previous decades. Domestic accidental injuries are also frequently reported; a comment on how many of these are truthfully accidental would be purely speculative. Indeed, domestic violence continues to be under-reported by many victims, and was only cited in 2 per cent of the case notes reviewed in the present study. Sport-related injury was also a common cause of nasal trauma in the present study; an overall increase in nasal fractures amongst young women could also be related to an increased participation in sport.

In almost a quarter of cases in the Luton and Dunstable Hospital, nasal injury was the result of non-domestic violence. This type of violence stems from interpersonal conflicts, and its rates have been associated with the consumption of alcohol. Moreover, at least two UK studies from the past decade showed that alcohol consumption was closely associated with a rise in anti-social behaviour, violence and criminality in young girls. In addition, a significant correlation between cheap, readily-available alcohol and violent injury was found in a study involving 58 accident and emergency departments in 10 distinct economic regions of the UK. Therefore, the increased incidence of nasal fractures amongst young women in the present study may, at least in part, be attributed to increasingly violent behaviour amongst young women.

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