American Association of Plastic Surgeons

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Closed Reduction of Nasal Fractures in the Emergency Department: Success or Failure?
Damon McIntire, B.A., Charles C. Jehle, Jr., M.D., Marten N. Basta, M.D., Albert S. Woo, M.D..
Brown University at Rhode Island Hospital, Providence, RI, USA.

PURPOSE:
Nasal bone fractures are the most common fractures of the face. Performing closed reduction acutely in the ED rather than electively treating fractures subacutely in the operating room may benefit patients, practitioners and healthcare systems. This study aims to evaluate the efficacy of closed reduction of nasal bone fractures in the emergency department.METHODS: A retrospective review of all patients presenting to our hospital undergoing ED reduction of nasal bone fracture from January 2016 through June 2017. Patient demographics, classification of their nasal bone fracture, method of treatment, clinical condition upon follow up and whether the patient underwent revision procedure were reviewed.
RESULTS: Of 485 patients evaluated by plastic surgery for consultation regarding a nasal bone fracture, 245 sustained isolated nasal bone fractures and 100 underwent a closed reduction by a plastic surgery resident in the ED. Nasal fractures were classified as described by Rohrich et. al. 6% were class I, 13.25% class II, 51.8% class III and 28.9% class IV. Reduction was performed with local anesthetic and po or iv analgesia. An elevator was used to address nasal bones along with Ashe forceps if septum was involved. 97% of patients were splinted and 41% had packing placed. At follow up 67.5% had a documented straight nasal dorsum, 25% with minimal deviation and 7.5% with clinically significant deviation. Only 2 patients ultimately elected to undergo subsequent operative reduction.
CONCLUSION:
Closed reduction of nasal bone fractures in the emergency room setting represents a safe, well-tolerated procedure with reasonably high success rates.


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