Management of Nasal Fractures in Sports
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LEADING ARTICLE
Management of Nasal Fractures in Sports Yashika Patel1 • Peter Goljan1 • Todd P. Pierce1 • Anthony Scillia1 Kimona Issa1 • Vincent K. McInerney1 • Anthony Festa1
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Ó Springer International Publishing Switzerland 2017
Abstract Nasal fractures represent approximately 60% of all maxillofacial injuries that occur in athletic activities; however, there are no current guidelines regarding immediate sideline management of these injuries. Therefore, the purpose of this article was to (1) summarize the anatomy, etiology, and incidence of nasal fractures, and (2) evaluate the current body of literature regarding immediate on-field and subsequent outpatient management. It is imperative to establish that the athlete’s airway is not compromised and there are no other severe concomitant injuries, such as a concussion, ocular injury, or leakage of cerebrospinal fluid. Immediate closed reduction should not be attempted unless there is airway compromise or the practitioner has experience in performing it. The majority of athletes with these injuries in isolation may return to play; however, in our practice, we recommend they wear a face mask for 6 weeks after their injury. Despite our recommendations, we know there is a paucity of clinical studies on immediate sideline and longer-term management. Future studies should focus on establishing therapeutic algorithms that will allow physicians to make treatment recommendations to patients with strong evidence to support their decision.
& Anthony Festa [email protected] 1
Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, 400 S Orange Ave, South Orange, NJ 07079, USA
Key Points When nasal fracture occurs during a game, it is imperative to establish that the airway is not compromised and that there are no other severe concomitant injuries such as concussion, eye injury, or leakage of cerebrospinal fluid. An attempt can be made to reduce most sport-related nasal fractures during the game if the practitioner has experience doing so. Most athletes with a nasal fracture can return to the game barring any other concurrent serious injuries.
1 Introduction Maxillofacial injuries are a common occurrence in athletic activities, compromising approximately 10% of all sportsrelated injuries [1–4]. More specifically, nasal injuries represent approximately 60% of this number [3, 4]. Despite their prevalence, definitive algorithms for on-field treatment of sports-related nasal fractures are lacking. Previous works detail outpatient management following fractures occurring mid-sport, but there are currently no official guidelines regarding immediate sideline treatment of such injuries [5]. The criteria used to determine when an athlete can be officially cleared to return to sporting activities remain unclear. Studies have suggested that patients suffering from nasal fractures ‘exercise caution’ during sport involvement for at least 4–6 weeks until bony healing is possible [6]; however, this timetable may be unreasonable in the setting
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