Closed Reduction

Appearance of the nose before reduction of the fracture


Nasal elevator is inserted into the nose to reduce the fracture


A nasal cast using a Murphy's splint is applied
  
 

One of the most common fractures in the head and neck is a broken nose or nasal fracture.  The nasal skeleton is made up of approximately 50% cartilage.  Diagnosis is primarily made on physical exam.  This use of "nasal films" is controversial since plain films will not show a cartilage fracture and if the nasal bones appear non-displaced on physical exam one does not need to set the nose.  Ideally, a nasal fracture should be set within 7 to 10 days in an adult and 5 to 7 days in a child, otherwise healing may prevent an optimal reduction.  For optimal reduction, it may be necessary to wait 3 to 4 days until the swelling subsides. 

Of importance is to rule out a nasal septal hematoma.  If a septal hematoma is not identified and drained within 24 hours, the nasal septal cartilage may die.  This can result in a saddle nose deformity.  

Fracture of the nasal cartilage usually produces a greenstick deformity which usually cannot be pushed back into place, since the cartilage retains a memory of the fracture and will slowly deviate back.   To obtain an adequate reduction an open reduction may have to be performed.  Mucosal flaps are elevated off the septal cartilage and bone.  The greenstick fractures are completed to mobilize the fragments and the displaced, non-supporting fragments are removed.      

A nasal fracture is defined as "open" if the nasal bones are exposed to the outside by a cut or tear in the skin or lining of the nose.  The procedure used to set the fracture is defined as "open" if cuts in the skin or nasal mucosa are made which allow insertion of instruments to set the nose or provides direct visualization of the fracture.    If the nose is set by pressure applied to the skin or with instruments placed into the nasal cavity, the reduction is defined as "closed".