A 28-year-old man sustains blunt trauma to the nose. Nasal bones appear fractured on examination. He presents 12 days later. The most appropriate management now is:
- A Reassess at 3 months and perform septorhinoplasty if deformity persists ✓
- B Closed reduction under local anaesthesia immediately
- C Observation — nasal fractures heal adequately without intervention
- D CT scan of nose and sinuses followed by rhinoplasty at 6 months
Correct answer: A. Reassess at 3 months and perform septorhinoplasty if deformity persists
Explanation
Closed reduction of nasal fractures should ideally be done within 7-10 days before the fracture consolidates. After 10-14 days, fibrous union makes closed reduction difficult and often unsuccessful. At 12 days, the appropriate management is to allow full bony consolidation over 3-6 months, then reassess for residual deformity. If cosmetic or functional deformity persists (deviated septum, nasal obstruction), formal septorhinoplasty is planned. Immediate forced closed reduction at 12 days risks poor cosmetic outcome and cartilage damage.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.