Comminuted nasal bone frature
Multiple small nasal fracture segments are very hard to put together with closed reduction after nasal bone trauma. Fortunately, there is no significant bone loss after fracture heals. However, lumps and irregularities are frequently present months after swelling subsides. In order to correct secondary nose deformity, full rhinoplasty including reshaping and cutting nasal bones, correction of nose cartilages and, very frequently, nasal septum is needed. About 50% of patients will need this type of surgery even after well executed closed reduction after fracture.
You should seek a consult of an experienced board certified plastic surgeon to discuss your options. Good luck.
The fragments of bone usually have some attachment to the periosteum so they are not free floating. They can be manipulated and held with a splint. There is skin outside and mucosa inside which, if not damaged, also will hold the fragments.
If the septum is intact for support then a closed reduction is the first step. After a year, if any issues persist, then some type of rhinoplasty may be needed to touch things up.
Nasal fracture repair
Trauma to the nose can cause a displaced or non-displaced nasal fracture. Just because the bones are comminuted doesn't have to be straightened unless there is a deviation of the nose when you look at it in the mirror. If the nose has been displaced, it can be put back into its normal straight position with either closed reduction or open reduction of the nasal fracture. In our practice, we prefer open reduction nasal fracture with medial and lateral osteotomies to realign all of the nasal bones properly. This is accomplished with a closed rhinoplasty approach whereby all the incisions were made on the inside of the nose. For many examples, please see the link and the video below