Reduction of a fracture

The timing is critical. Reduction is performed either:

• immediately - before swelling has developed
• after 7-10 days - when the swelling has settled but the nose can still be manipulated

Reduction may be done under local or general anaesthetic:

• the procedures usually followed are: (1)
  • closed reduction
    • limited to mild unilateral fractures.
    • can be done in the primary care setting
  • open reduction
    • usually done in the operating thaetre
• simple lateral angulation may be reduced by digital pressure on the nose, success being greeted with an audible click
• depressed bones may require elevation with forceps
• a nose which is unstable after reduction should be splinted with plaster of Paris

Fractures which are reduced too late will require a formal septorhinoplasty.

Reference:

(1) Corry J. Kucik. Management of acute nasal fractures.Am Fam Physician 2004;70:1315-20