Nasal fracture with and without displacement
- Fracture classification
- Signs and symptoms of a broken nose
- First aid for a broken nose
- Nose fracture treatment
Nose fractures account for 40% of the total number of facial injuries, since this organ protrudes above its surface and is therefore the most vulnerable. In most cases, this fracture occurs as a result of direct injury.
The main reasons for the appearance of this type of injury are fights (34%), traffic accidents and accidents (28%), sports activities (23%), as well as accidental falls, to which children are mainly exposed.
As a result, the bone that forms the back of the nose, or the cartilaginous tissue from which its front part and lateral wings are formed, are injured.
Like any other fracture, a fracture of the nasal bones can be closed and open, with or without displacement. With a closed fracture, the integrity of the tissues and skin around the broken bone is not disturbed; with an open fracture, an open wound is formed, through which fragments of bone can be seen. An open fracture is dangerous with high blood loss and the risk of infection.
With a closed fracture without displacement, the shape of the nose does not change, edema appears on the face, and a bruise forms at the site of the injury. The point of localization of the fracture can be detected by palpation. X-rays will be required to confirm. Visually, a depression of the nose can be noted, in small children, a sinking of the nasal bone. With severe trauma, ruptures of the nasal mucosa are possible.
An open fracture without displacement is characterized by the same signs, which are complemented by a violation of the integrity of the skin and mucous membrane at the fracture point and the presence of protruding bone fragments.
A displaced nasal fracture is a more complex and severe injury that can cause breathing disorders and have such long-term consequences as disorders of water and electrolyte balance, purulent lesions of soft tissues, trigeminal neuritis, etc., not to mention a cosmetic defect and the need carrying out rhinoplasty.
Most often, displacement occurs to the side. It is possible to displace the entire nose as a whole, in which the shape of its back does not change. Such deformation is visually unnoticeable. The cartilage tissue is quite elastic, so it lends itself well to reposition when displaced.
In most cases, the classification of nose fractures according to Yu. N. Volkov is used, which takes into account the nature of the injury, the strength and direction of the blow.
According to this classification, nose fractures are:
- No bone displacement and deformation of the outer part of the nose;
- With displacement and deformation;
- With damage (curvature) of the nasal septum;
- With damage to the processes of the maxillary bone;
- With the divergence of the nasal bone at the seams.
Signs and symptoms of a broken nose
The main symptoms of a broken nose include:
- Severe pain in the nasal region, which is aggravated by touching and feeling;
- Increasing swelling of tissues in the nose;
- Bruising (bruising) around the nose and under the eyes;
- A change in the shape of the nose, which can be observed even with closed fractures and without displacement and is a consequence of edema;
- Epistaxis, which may be intense or scarce, but difficult to stop anyway;
- Discharge from the nose of a mucous nature;
- Difficulty in nasal breathing.
A day after the injury, edema captures the area of the cheekbones and eyelids, nasal breathing is absent. With a splinter fracture, a phenomenon such as crepitus (a characteristic crunch when touched) and pathological mobility can be observed.
Severe symmetrical bruises around the eyes, especially if they did not appear immediately, but gradually, may indicate not only an injury to the nose, but also a fracture of the bones of the skull base, therefore, in this case, it is recommended to immediately conduct an appropriate examination (MRI or CT of the skull base and cervical spine spine).
First aid for a broken nose
The first step is to try to stop the nosebleeds. To do this, in winter, you can apply snow or ice to the bridge of the nose. In summer, you can attach a handkerchief or piece of clothing to your nose, turning your head to the side and throwing it back a little.
In the event of a fracture with displacement, the victim should be taken to a medical facility as soon as possible and nothing should be done on their own.
A fracture without displacement is often mistaken for a simple injury, in this case, an X-ray must be taken to clarify the diagnosis.
Nose fracture treatment
The doctor finds out the circumstances in which the injury was received, palpates the nose, then rhinoscopy, endoscopy and radiography are prescribed. X-ray allows you to determine the degree of damage, the fracture line, the presence or absence of displacement and bone fragments. With the help of X-rays, a fracture can be detected in the early stages, when there is still no significant swelling and inflammation of the soft tissues.
A fracture without displacement is treated with conservative methods: the injury site is cooled and pain relievers are used (ketanov, dexalgin). Sometimes vasoconstrictor drugs are prescribed in the form of nasal drops, but they cannot be abused. To relieve swelling and eliminate bruises, you can use ointments (troxivazine, rescuer).
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In case of a fracture with displacement and the presence of fragments, a surgical operation is performed - reposition of the nasal bones. It is recommended to carry it out within 7-10 days after the injury, not later, in this case it will be possible to do without general anesthesia. During the operation, application and injection anesthesia is performed (2% lidocaine), then the sunken bone is lifted using a special elevator and the nose is fixed with tampons containing antibiotics. Tampons are installed for at least 3 days.
If more than 10 days have passed since the injury, then rhinoplasty or septoplasty (correction of the nasal septum) will be required. In the event of a curvature of the nasal septum, an abscess, chronic rhinitis or sinusitis can become negative consequences of a nasal fracture.
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.