If at First You Don't Succeed: Identifying the Risk Factors for Repeat Operative Intervention in Patients with Nasal Bone Fractures that Underwent Initial Bedside Closed Reduction.
Vinay Rao, MD, MPH, Ronald A. Akiki, BA, Carole Spake MSc, Joseph Crozier, MA, Albert Woo, MD
Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
Background: Bedside closed nasal bone reduction is often performed for patients presenting with nasal bone fractures in the acute setting. Failed nasal bone reductions requiring subsequent revision in the Operating Room (OR) are associated with increased patient morbidity as well as a delay to definitive intervention. In this study, we aim to identify the key risk factors that are associated with failure of bedside closed nasal bone reduction and need for future revision.
Methods: A case control study was performed identifying 20 patients with nasal bone fractures who required subsequent revision in the operating room and 20 matched controls. All patients included in the study underwent initial closed reduction in the Emergency Department and were performed using the same technique. Patient records were reviewed for important factors that may have contributed to failure of bedside closed nasal bone reduction. Odds were calculated for each of these exposures and statistical differences between groups were calculated using chi squared and Fisher exact tests where appropriate.
Results: The average age for patients presenting with nasal bone fractures requiring reduction was 42.5 years old and 32% were females. Bilateral nasal bone fractures, presence of comminution, severe clinical deviation, and concomitant facial fractures all demonstrated a statistically significant increased odds for requiring subsequent operative intervention (Table 1).
Conclusion: Strong consideration for formal operative intervention should be given for patients presenting with severely displaced comminuted nasal bone fractures with concomitant facial fractures. If patients with these fractures undergo bedside intervention, patients should be counseled on the increased odds of requiring future revision and should be followed closely.
Back to 2021 Abstracts