What is the recommended treatment for a minimally displaced nasal bone fracture?

Treatment for Minimally Displaced Nasal Bone Fractures

For minimally displaced nasal bone fractures, closed reduction is the recommended first-line treatment, which should be performed after swelling has subsided (typically 3-10 days after injury) to achieve optimal functional and aesthetic outcomes. 1

Initial Assessment and Timing

• Accurate diagnosis is based primarily on thorough history and careful physical examination, with radiographic imaging not being necessary for diagnosis in most cases 2
• Treatment should be delayed until 3-10 days after injury when edema has resolved, except in cases of grossly displaced fractures, open fractures, or septal hematomas which require immediate intervention 2
• Clinical assessment should evaluate both functional (airway patency, nasal obstruction) and aesthetic parameters (facial symmetry, nasal deviation) 1

Treatment Approach

Closed Reduction

• Closed reduction under local anesthesia is the preferred initial approach for minimally displaced nasal fractures, offering a conservative and effective treatment option 1, 3
• Local anesthesia provides comparable outcomes to general anesthesia in terms of cosmesis, pain control, and resolution of nasal obstruction 3
• The procedure involves:
  • Proper anesthetic administration (topical and/or injectable)
  • Manual realignment of the nasal bones to their anatomical position
  • External nasal splinting for stabilization 1

Technique Considerations

• To minimize destabilization of the osseous nasal framework, manipulation should preserve periosteal and mucosal attachments of the nasal bone 4
• Nasal bone mobilization should be achieved using the smallest possible manipulative force necessary to achieve reduction 4
• External nasal splinting should be maintained for approximately 7-10 days to support the reduced nasal bones 1

Special Considerations

• If closed reduction fails to achieve satisfactory alignment, referral for open reduction may be necessary 5
• For cases with associated septal deviation, additional septal correction may be required to achieve both functional and aesthetic improvement 4
• Patients should be advised that secondary rhinoplasty may be required in approximately 15-20% of cases if the initial reduction does not achieve optimal results 5

Follow-up and Outcomes

• Follow-up evaluation should assess both functional outcomes (breathing, airway patency) and aesthetic results (symmetry, alignment) 1
• Patient satisfaction should be measured using standardized assessment tools such as visual analog scales for both functional and aesthetic parameters 1
• Most patients experience significant improvement in both functional and aesthetic parameters following closed reduction of nasal fractures 1

Potential Complications

• Inadequate reduction may lead to persistent nasal deformity or airway obstruction 5
• Visible irregularities or step-off deformities may occur, especially in areas with thin overlying skin 6
• Delayed treatment beyond 2-3 weeks may result in poorer outcomes due to early bone healing in a displaced position 2