scholarly journals Comparison of the outcomes of nasal bone reduction using serial imaging

2021 ◽  
Vol 22 (4) ◽  
pp. 193-198
Author(s):  
Cho Long Lee ◽  
Ho Jik Yang ◽  
Young Joong Hwang
Keyword(s):  
Closed Reduction ◽  
Bone Fractures ◽  
Nasal Bone ◽  
Ct Scans ◽  
Complication Rates ◽  
Short Operative Time ◽  
Radiographic Images ◽  
Initial Results ◽  
Subsequent Intervention

Background: Nasal bone fractures are frequently encountered in clinical practice. Although fracture reduction is simple and correction requires a short operative time, low patient satisfaction and relatively high complication rates remain issues for many surgeons. These challenges may result from inaccuracies in fracture recognition and assessment or inappropriate surgical planning. Findings from immediate postoperative computed tomography (CT) scans and those performed at 4 to 6 weeks postoperatively were compared to evaluate the accuracy and outcomes of nasal fracture reduction.Methods: This retrospective study included patients diagnosed with nasal bone fractures at our department who underwent closed reduction surgery. Patients who did not undergo additional CT scans were excluded from the study. Clinical examinations, patient records, and radiographic images were evaluated in 20 patients with nasal bone fractures.Results: CT findings from immediately after surgery and a 1month follow-up were compared in 20 patients. Satisfactory nasal projection and aesthetically acceptable results were observed in patients with accurate correction or mild overcorrection, while undercorrection was associated with unfavorable results.Conclusion: Closed reduction surgery for correcting nasal bone fractures usually provides acceptable outcomes with relatively few complications. If available, immediate postoperative CT scans are recommended to guide surgeons in the choice of whether to perform secondary adjustments if the initial results are unsatisfactory. Based on photogrammetric data, nasal bone reduction with accurate correction or mild overcorrection achieved acceptable and stable outcomes at 1 month postoperatively. Therefore, when upward dislocation is observed on postoperative CT, one can simply observe without a subsequent intervention.

scholarly journals A retrospective clinical investigation for the effectiveness of closed reduction on nasal bone fracture

2019 ◽  
Vol 41 (1) ◽  
Author(s):  
Byung-Hun Kang ◽  
Hyo-Sun Kang ◽  
Jeong Joon Han ◽  
Seunggon Jung ◽  
Hong-Ju Park ◽  
...  
Keyword(s):  
Bone Fracture ◽  
Closed Reduction ◽  
Traffic Accident ◽  
Bone Fractures ◽  
Clinical Investigation ◽  
Nasal Bone ◽  
Surgical Techniques ◽  
High Rate ◽  
Radiographic Images ◽  
Current Trends

Abstract Background The nasal bone is the most protruding bony structure of the facial bones. Nasal bone fracture is the most common facial bone fracture. The high rate of incidence of nasal bone fracture emphasizes the need for systematical investigation of epidemiology, surgical techniques, and complications after surgery. The objective of this study is to investigate the current trends in the treatment of nasal bone fractures and the effectiveness of closed reduction depending on the severity of the nasal bone fracture. Patients and methods A total of 179 patients with a nasal bone fracture from 2009 to 2017 were enrolled. Their clinical examination, patient’s records, and radiographic images of nasal bone fractures were evaluated. Results Patients ranged from children to elderly. There were 156 (87.2%) males and 23 (12.8%) females. Traffic accident (36.9%) was the most common cause of nasal fracture. Orbit fracture (44 patients, 24.6%) was the most common fracture associated with a nasal bone fracture. Complications after surgery included postoperative deformity in 20 (11.2%) patients, nasal obstruction in 11 (6.1%) patients, and olfactory disturbances in 2 (1.1%) patients and patients with more severe nasal bone fractures had higher rates of these complications. Conclusion Closed reduction could be performed successfully within 2 weeks after injury.

scholarly journals Does the quality of preoperative closed reduction of displaced ankle fractures affect wound complications after surgical fixation?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0018
Author(s):  
Bonnie Chien ◽  
Kristen Stupay ◽  
Christopher Miller ◽  
Jeremy Smith ◽  
Jorge Briceno ◽  
...  
Keyword(s):  
Classification System ◽  
Closed Reduction ◽  
Ankle Fracture ◽  
Ankle Fractures ◽  
Wound Complications ◽  
Complication Rates ◽  
Ankle Osteoarthritis ◽  
Surgical Fixation

Category: Trauma Introduction/Purpose: Prompt reduction and stabilization of displaced ankle fractures is important to protect soft tissues, restore potential neurovascular deficits and prevent cartilage injury. Many of these injuries do eventually require surgical fixation. The purpose of this study is to determine whether the initial quality of ankle closed reduction based on radiographic criteria would affect outcomes such as ankle osteoarthritis and complications after surgery. Furthermore, we sought to develop a classification system for the quality of closed reduction that would be easy to use and provide interrater reliability. Methods: A retrospective analysis of patients who sustained isolated, closed ankle fractures with at least 3 months follow up postoperatively at two level 1 trauma centers was performed. Patient demographics and history, ankle fracture characteristics and reduction information as well as surgical outcomes and complications were collected. A grading classification for the quality of the initial closed reduction before surgery was developed based on standard AP or mortise and lateral ankle x-rays. The factors considered for rating the reduction included the degree of talar shift on the AP/mortise view, malleoli displacement, as well the relationship of a central plumb line to the center of the talar dome on the lateral x-ray. For ankle osteoarthritis, the Takakura classification was utilized. Three reviewers (1 resident, 2 attendings) independently reviewed and rated all imaging. Results: 161 patients were analyzed. 65% female, average age 50, average 4 days between injury and surgery, mean follow up of 12 months (3-58 months), and 17% wound complications. Psychiatric history was the single comorbidity significantly associated with complications (p=0.009). There was no difference in wound or infection complication rates based on initial closed reduction quality (p=0.17). Neither number nor quality of reductions correlated with increased osteoarthritis (p=0.19, 0.39 respectively). Worst graded reductions had shorter time to surgery, mean 1.4 vs 4.7 days for best reductions (p=0.03), suggesting a protective factor that may account for no association between reduction quality and wound complications. Interclass correlation coefficients for multiple observers showed very high consistency for grading of reduction quality based on the classification system (ICC >0.85, p<0.001). Conclusion: It is often emphasized that a displaced ankle fracture should be as perfectly reduced as possible, understandably for grossly dislocated ankle fracture dislocations potentially compromising skin and neurovascular structures. At the same time, this original study demonstrated contrary to common assumption that the initial quality of ankle closed reduction does not appear to affect the severity of ankle osteoarthritis or the rate of surgical complications. This study also developed a highly reproducible ankle reduction classification system. It opens the opportunity for future prospective application and analysis of this classification’s ultimate clinical utility.

scholarly journals External Fixation of Unstable, “Flail” Nasal Fractures

2012 ◽  
Vol 5 (2) ◽  
pp. 99-105 ◽  
Author(s):  
George E. Anastassov ◽  
Ali Payami ◽  
Zain Manji
Keyword(s):  
External Fixation ◽  
Closed Reduction ◽  
Nasal Septum ◽  
Bone Fractures ◽  
Nasal Bone ◽  
Facial Fractures ◽  
Kirschner Wires ◽  
Nasal Bones ◽  
External Stabilization ◽  
Nasal Fractures

Nasal bone fractures are the most common among facial fractures. Usually these are adequately treated with closed reduction and internal and/or external stabilization with splints. However, there are clinical situations where the nasal bones are severely displaced, the nasal septum fractured and displaced, or there are external drape lacerations which preclude the use of nasal splints. If the nasal bones are reducible but unstable we consider them “flail” and in this case transmucosal, endonasal Kirschner wires are used for dorsal support until sufficient healing occurs. The technique is simple, quick, and predictable and causes minimal discomfort to the patients.

scholarly journals Understanding Nasal Bone Fractures and Its Effects on Management: A Prospective Study

2014 ◽  
Vol 7 (2) ◽  
pp. 58-60
Author(s):  
Nayanjyoti Sarma ◽  
Abhinandan Bhattacharjee
Keyword(s):  
Prospective Study ◽  
Closed Reduction ◽  
Bone Fractures ◽  
Nasal Bone ◽  
Real Patient ◽  
Management Options ◽  
Different Types ◽  
A Prospective Study ◽  
Type Of Fracture

ABSTRACT Objective To evaluate mode of injury and different management options reliant on types of nasal bone fractures. Study design Prospective analytical study. Subjects and methods Seventy-five patients with nasal bone fractured were clinically and radiologically evaluated and divided into different types according to Lee's classification. They were provided conservative, closed reduction and/or osteotomy according to the type of fracture and outcome noted. Results Lee's classification is found to be valid in real patient scenarios and using good radiological evaluation better post operative outcome can be achieved. For type 1 and 3 fractures, closed reduction and osteotomy are the treatment of choice. Conclusion We confirm that systematic approach on Lee's classification for nasal bone fracture can be used to select appropriate management strategy. How to cite this article Sarma N, Bhattacharjee A. Understanding Nasal Bone Fractures and Its Effects on Management: A Prospective Study. Clin Rhinol An Int J 2014;7(2):58-60.

scholarly journals Effectiveness of Closed Reduction in the treatment of nasal bone fractures

2021 ◽  
Vol 23 (1) ◽  
pp. 37-40
Author(s):  
Brihaspati Sigdel ◽  
K Sah
Keyword(s):  
Bone Fracture ◽  
Closed Reduction ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Bone Fractures ◽  
Nasal Bone ◽  
College Teaching ◽  
Road Traffic Accidents ◽  
Functional Abnormality ◽  
Nasal Injury

This study was conducted to investigate the effectiveness of closed reduction of nasal bone fracture according to severity. It was a retrospective study carried on 60 patients with mean age of 30.2 years (range 10-67 years) who have undergone a closed reduction of a nasal bone fracture at Gandaki Medical College Teaching Hospital from January 2017 to December 2019. The patient with nasal bone fracture who underwent surgical intervention with closed reduction under General anaesthesia were included in this study. Fracture severity was evaluated according to Hwang et al.’s classification method. All patients underwent closed reduction with external nasal splinting under General anesthesia. The patients were followed-up for at least three months to assess the complications, such as fracture recurrence and functional abnormality in the Department. The most common cause of nasal bone fracture was road traffic accidents 25 (41.6%) followed by physical assaults 18 (30%), fall injuries 12 (20%), other incidences 3 (5%), and industrial accidents 2 (3%). Forty-three (72%) cases underwent closed reduction within 24 hours of those who arrived within 4-6 hour of nasal injury in the hospital and the remaining 17 (28%) cases were reduced after 5 days of trauma. Concurrent fracture found in 8 (13%) cases and it included maxillary, zygomatic, orbital, frontal bone fracture. Nasal bone fracture mostly occurs in road traffic accidents. Closed reduction with good alignment is the preferred method. Septorhinoplasty and extracorporeal septoplasty should be applied in difficult and comminuted nasoseptal fracture.

scholarly journals Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases

2020 ◽  
Author(s):  
Hong-An Zhang ◽  
Chun-Hao Zhou ◽  
Xiang-Qing Meng ◽  
Jia Fang ◽  
Cheng-He Qin
Keyword(s):  
Intramedullary Nailing ◽  
Distraction Osteogenesis ◽  
Intramedullary Nail ◽  
Calcium Sulfate ◽  
Bone Fractures ◽  
Weight Bearing ◽  
Bone Transport ◽  
Complication Rates ◽  
Nail Removal

Abstract Background: The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing: intramedullary nail removal, local debridement, reaming and irrigation, and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis. Methods: We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2017 at our center. Patients with follow-up of less than 24 months, received other treatment methods, or those with serious medical conditions were excluded from the analysis. Patients met the criteria were treated as described above, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate, and post-operative complication rates were assessed. Results: A total of 19 patients were included in the analysis. All of patients had satisfactory outcomes with an average follow-up of 38.1 ± 9.4 months (range, 24 to 55months). Eighteen patients (94.7%) achieved infection remission; 1 patient (5.3%) developed a reinfection that resolved after repeat debridement. Nine patients with bone defects (average size 4.7 ± 1.3 cm; range, 3.3 to 7.6 cm) were treated with bone transport which successfully restored the length of involved limb. The mean bone transport duration was 10.7 ± 4.0 months (range, 6.7 to 19.5 months). The majority of patients achieved full weight bearing and became pain free during the follow-up period. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively. Conclusion: Intramedullary nail removal, canal reaming and irrigation, and antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) is effective for treating infections after intramedullary nailing.

scholarly journals Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong-An Zhang ◽  
Chun-Hao Zhou ◽  
Xiang-Qing Meng ◽  
Jia Fang ◽  
Cheng-He Qin
Keyword(s):  
Intramedullary Nailing ◽  
Distraction Osteogenesis ◽  
Intramedullary Nail ◽  
Calcium Sulfate ◽  
Bone Fractures ◽  
Weight Bearing ◽  
Bone Transport ◽  
Complication Rates ◽  
Nail Removal

Abstract Background The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing: intramedullary nail removal, local debridement, reaming and irrigation, and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis. Methods We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2017 at our center. Patients with follow-up of less than 24 months, received other treatment methods, or those with serious medical conditions were excluded from the analysis. Patients met the criteria were treated as described above, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate, and post-operative complication rates were assessed. Results A total of 19 patients were included in the analysis. All of patients had satisfactory outcomes with an average follow-up of 38.1 ± 9.4 months (range, 24 to 55 months). Eighteen patients (94.7%) achieved infection remission; 1 patient (5.3%) developed a reinfection that resolved after repeat debridement. Nine patients with bone defects (average size 4.7 ± 1.3 cm; range, 3.3 to 7.6 cm) were treated with bone transport which successfully restored the length of involved limb. The mean bone transport duration was 10.7 ± 4.0 months (range, 6.7 to 19.5 months). The majority of patients achieved full weight bearing and became pain free during the follow-up period. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively. Conclusion Intramedullary nail removal, canal reaming and irrigation, and antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) is effective for treating infections after intramedullary nailing.

Overlay grafting for lateral nasal wall concavities

1998 ◽  
Vol 119 (4) ◽  
pp. 385-388 ◽  
Author(s):  
Scott E. Gilbert
Keyword(s):  
Patient Satisfaction ◽  
Revision Rate ◽  
Bone Fractures ◽  
Nasal Bone ◽  
Lateral Nasal Wall ◽  
Nasal Airway ◽  
Nasal Cartilage ◽  
Crooked Nose ◽  
Nasal Vault

One of the most difficult maneuvers in rhinoplasty is achieving a straight dorsum in the patient with a crooked nose. Often this deformity is a result of trauma involving the bony and cartilaginous vaults, resulting in nasal bone fractures and avulsion of the lateral cartilages into the nasal airway. Reduction of nasal bone fractures is fairly straightforward, but the repair of nasal cartilage trauma is more problematic. The cartilage of the nasal vault possesses fibrous attachments, which when disturbed, are difficult to reestablish. Overlay grafts are known to be effective in filling these defects and creating the illusion of a straight nose. In this series, during an 8-year period, 89 grafts were placed over lateral nasal wall concavities during rhinoplasty. Results after a minimum of 1 year follow-up are reviewed, as well as technique, materials, complications, revision rate, and patient satisfaction.

Is Surgical Navigation Useful During Closed Reduction of Nasal Bone Fractures?

2017 ◽  
Vol 28 (3) ◽  
pp. e208-e210 ◽  
Author(s):  
Seon Tae Kim ◽  
Joo Hyun Jung ◽  
Il Gyu Kang
Keyword(s):  
Closed Reduction ◽  
Surgical Navigation ◽  
Bone Fractures ◽  
Nasal Bone

The Effect of COVID on Nasal Fracture Management in ENT Emergency Clinics

2021 ◽  
pp. 194338752110150
Author(s):  
Keshav Kumar Gupta ◽  
Vinay Kumar Gupta ◽  
Ranjodh Singh Sanghera ◽  
Karan Jolly ◽  
Lisha McClleland
Keyword(s):  
Bone Fractures ◽  
Management Strategies ◽  
Nasal Bone ◽  
Nasal Fracture ◽  
Number Of Patients ◽  
Fracture Management ◽  
Significant Difference ◽  
The Uk ◽  
Nasal Fractures

Study design: Retrospective cohort study. Objective: Management of nasal fractures is usually in ENT emergency clinics, with our center aiming to assess patients within 10-days. During 2020, there have been numerous lockdowns and social distancing measures implemented in the UK as a result of the coronavirus pandemic (COVID). This study aimed to assess the effect of COVID on nasal fracture management in ENT emergency clinics in terms of number of patients seen, time to follow up and their management strategies. Methods: All patients with suspected or confirmed nasal bone fractures presenting to the emergency department (ED) between January 1, 2019 and December 31, 2020 at our major trauma center were analyzed in 2 groups depending on the year they were seen (2019 vs. 2020). Results: There was a total of 104 patients analyzed, with 51.4% decrease in the number of patients seen in 2020 versus 2019. The mean days to follow up in 2019 was 8.09 days and 7.65 days in 2020 ( P = .37). There was no statistically significant difference in the number of patients seen within the 10-day target between years (2019 = 65.7% vs. 2020 = 76.5%, P = .35). The majority of patients were managed with manipulation under anesthesia (MUA) in 2019 (n = 32, 45.7%) vs. discharge from clinic in 2020 (n = 21, 61.8%). Conclusions: Our study shows a drastic reduction in the number of patients seen in ENT emergency clinic from 2019 to 2020. This is in-keeping with other studies that have shown a reduction in ED attendances, trauma admissions and admissions across other specialties all around the world.

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