A 28-year-old man sustains a blunt trauma to the nose. On examination, there is lateral displacement of the nasal bones, bilateral periorbital ecchymosis, and crepitus on palpation. The optimal timing for closed reduction of a nasal fracture is:
- A Immediately in the emergency department within 1–2 hours of injury
- B After 3 weeks when the fracture is stabilised
- C 5–10 days after injury, when swelling subsides but before bony union ✓
- D Immediate open rhinoplasty regardless of timing
Correct answer: C. 5–10 days after injury, when swelling subsides but before bony union
Explanation
Closed reduction of nasal fractures is ideally performed either within 3 hours (before massive oedema) or 5–10 days after injury (once swelling subsides) but before fibrous union begins at 2–3 weeks. Most patients present after significant swelling has developed, making the 5–10 day window the practical standard. After 3 weeks, bony union has progressed sufficiently that closed manipulation is ineffective and open rhinoplasty or delayed septorhinoplasty (at 3–6 months) is required.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.