Nasal fracture fixed via closed reduction

I think you
may be reading a little too much into your doctors operative note. There are 2 nasal bones, one on the left and
one on the right. They are attached to
each other and the septum is in the middle. Superiorly and laterally they are attached to other bones of the
face. These bones are very thin (about
the thickness of a credit card), and can be easily broken or shattered (think
like cracking an egg). Nasal fractures
are the most common fracture in facial trauma. And it is not uncommon to have a comminuted nasal fracture. In the immediate period after an injury (the
first 10 days) the most appropriate management is a closed reduction just as
your doctor described. This takes the
fragments of bone and sets them back to the appropriate position they started
in. If after this the nose heals and is
still crooked, a rhinoplasty (either open or closed) with osteotomies may be
done (no sooner than 6 weeks later) to re-break the bones and set them in the
correct position. The nose is not like
larger bones in your body in your arms, legs or even jaw, where a fracture can
be repaired with open reduction and internal fixation with plates and screws. These are almost never used in nasal surgery.

Closed reduction is the most appropriate and most commonly used method for treating a typical nasal fracture in the early stage after an injury.I prefer to attempt closed reduction within the first 7-10 days after the injury.  In younger patients such as adolescents and teenagers I have found that they begin to heal and re-fuse the broken bone segments faster than most adults, so I try to treat their fractures within 1 week at most.Waiting a few days after the injury is helpful to allow some of the initial swelling to improve if the fracture repair cannot be performed within the first few hours after injury.I think you are reading too much into the semantics of an old operative report.  Even if the left nasal bone had some comminution, a closed reduction as you described still seems like the most appropriate first step assuming it was a typical nasal fracture.

Closed reduction of nasal fracture is pretty standard in the first few weeks after rhinoplasty.  Unfortunately, even when properly done, it is not uncommon to require a formal rhinoplasty later on.  Open rhinoplasty is not usually done in the first days or weeks after nasal fracture unless it is extremely complicated.

It sounds as if the bones were still quite mobile and could be easily manipulated either via manual pressure or a via a simple blunt elevator. Even if the bones are in many little pieces this is still generally the best option in the first 3 weeks following injury. An open reduction probably would not have offered any additional benefit.

Closed reduction is all you need for nasal bones. Closed reduction and a splint. Sometimes only one side is broken. Fractures broken in multiple pieces are more likely to heal improperly after injury, but a closed reduction is still the correct treatment.

 In our practice, we rarely ever perform a closed reduction of the nasal fracture. A closed reduction must be performed within the first week after the injury. Most patients undergo osteotomies of the nasal bones to straighten them, which is also considered open reduction of a nasal fracture. The open reduction of the nasal fracture can be performed with a closed rhinoplasty approach. In addition, a cartilaginous spreader graft is sometimes required to be placed underneath the concave upper lateral cartilage in the midportion of the nose to help straighten it. For many examples and more information, please see the link and the video below

Either closed or open reduction for nasal fractures following trauma are appropriate, depending on the situation.  If you are not satisfied with the results, then you may consider a revision rhinoplasty surgery.  The best recommendation is to have an in-person evaluation and consultation with a board certified specialist who can assist you with achieving the results you seek. 3-dimensional computer imaging can help you visualize what you may look like afterwards and serve as an important communication tool with your surgeon.

Closed reduction of a nasal bone fracture is something that is best within approximately 1 week of the injury. Everything is a case by base basis, depending on the other surrounding fractures on the face, but I typically do open reduction of nasal fractures only if needed 3-6 months after the initial injury or closed reduction has healed.

The main question is are you happy with your nose; if you are, its irrelevant how your surgeon corrected your nose; if you are not satisfied, then you can have him revise it. It would not be possible to answer your question as not possible to convey what your surgeon really did to correct your nose with a couple of sentences.

  Hi, I performed numerous closed nasal reductions while training at LAC/USC during the mid to late 80's.  Closed nasal reduction is a general "fix" that can be done without a surgical procedure like Rhinoplasty.  The bad news is that a closed reduction lacks the specificity of reducing the nasal fractures and reshaping the nose offered by a Rhinoplasty.  It's like comparing apples and oranges.  Rhinoplasty gives better results in my opinion.Hope this helps.