Should I have closed reduction surgery on my broken nose now or have open reduction surgery latter? Please help. (photo)

While building a shelter with students a branch fell and broke the bridge of my nose. Both the ER doctor and the ENT described this break as a comminuted fracture. My ENT said that I can choose to have closed surgery now and that I may potentially need/want to have open surgery latter or I could choose to wait and just have open surgery. I worry that workmans comp. would not cover the 2nd surgery if I was not happy with the results of the first closed one. Would waiting cause damage? Thank you!

Doctor Answers 11

Closed Reduction Now or Open Reduction Later Correct Broken Nose

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I assume your pictures are current indicating that the trauma was recent. You do have deviation of the lower cartilagenous portion of your nose which will not be adequately corrected using the closed reduction technique. I would use the open reduction technique whether it is in the near future or when the surgery might b more convenient. Either way a  good result can be achieved if you select an experienced rhinoplasty surgeon and  I cannot imagine your workman's comp policy would not cover the surgery if it is recommended by your surgeon. Consult with your carrier.

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Should I have closed reduction surgery on my broken nose.

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With a nasal fracture, we feel it best to complete a closed reduction as soon as possible which for most will avoid the need for further surgery or lasting airway issues down the road.

Nasal trauma issue

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If you recently( in the past week or so) broke your nose, then it is often a good idea to have a closed reduction to attempt to centralize the nose. I routinely tell patients to expect to require a more formal rhinoplasty in 6 months or so to refine irregularities or bumps.

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Nasal trauma

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I would recommend doing the closed reduction now.  This may reposition your nasal bones adequately so you do not have the nasal asymmetry.  Once the bones heal, it may be harder to reposition these and obtain a straight nose again.  The only caveat is that you may still require an open procedure if you are not happy with the results of the closed reduction.  

Open reduction of the nasal fracture with a closed rhinoplasty approach

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In our practice, closed reduction does not work very well, especially with the commented nasal fractures. When a significant nasal fracture exists, it is better to perform an open reduction of the nasal fracture with osteotomies placed in nasal bones and setting the nasal bones straight. In addition, a cartilaginous spreader draft harvested from inside the nose may be required to be placed underneath the upper lateral cartilage in the midportion of the nose which is concave. Open reduction of the nasal fracture is usually performed with a closed rhinoplasty approach by placement of all the incisions on the inside of the nose. Treatment of the twisted and broken nose is a difficult endeavor, so choose your rhinoplasty surgeon based on extensive experience. For more information about crooked nose repair and many before-and-after examples, please see the link and the video below

Closed reduction vs. open fixation

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As others have mentioned, you are much better off performing a closed reduction as soon as possible to try and set the bones back to their natural position.  There is extensive data that shows that this decreases the risks of needing future surgery.  Not only that, but it will help immediately with your breathing and cosmesis as well.  Best of luck! 

Miguel Mascaro, MD
Delray Beach Facial Plastic Surgeon
5.0 out of 5 stars 16 reviews

Should I have closed reduction surgery on my broken nose now or have open reduction surgery latter? Please help.

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In most cases, it is better to fix it as soon as possible before the bone heals in the wrong position. 

Nasal Fracture Recommendations

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You appear to have a displaced, comminuted fracture of the nasal bones from your injury. In my view, it would be best to have the closed reduction of nasal bone fracture with external stabilization within 3 weeks to straighten the nasal bones now. If you should require additional corrective surgery in 6-12 months for nasal airway or additional nasal bone correction, you will generally do better if you had the closed reduction first. Insurance and Workman's comp benefits usually care through to complete recovery. If you are not sure about your benefits, speak to your surgeon's office or insurance representative for clarification. Find an experienced Facial Plastic Surgeon for confirmation and recommendations. Best Wishes. 

Fred J. Bressler, MD, FACS
Houston Facial Plastic Surgeon

Rhinoplasty - timing of closed reduction surgery

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There is very good data that nasal reduction/realignment after trauma reduces the risks of requiring further surgery.  I recommend reducing the bones and likely the internal nasal septum into the best possible alignment within a couple of weeks.  The secondary surgery for injured noses like yours is difficult as the nose has healed crooked.  Crooked nose surgery is actually quite difficult.  Consider getting a second opinion with a surgeon who is experienced with both cosmetic and traumatic nasal surgery.  A good starting point is always a board certified plastic surgeon but perhaps search out one who specializes or does many noses.  Best Wishes!! 

Treating a fractured nose: ASAP or delayed?

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Our noses are similar to A-frame houses: with a fracture to the bones the nose becomes deviated, and like a house with displaced walls, needs correction. When the deviation is visible often the inner septum (inner wall) is also deviated. All of this will require surgery, to reposition the deviations and possibly using some cartilage grafts. This ‘open reduction’ can be performed either now or later. While the early closed reduction is often used, it probably won’t adequately deal with all the factors and will likely still require a second surgery later. 

Donn R. Chatham, MD
Louisville Facial Plastic Surgeon
5.0 out of 5 stars 74 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.