Department of Plastic and Reconstructive Surgery, Alanya Alaaddin Keykubat University Faculty of Medicine, Antalya-Türkiye.
Department of Emergency Medicine, Alanya Alaaddin Keykubat University Faculty of Medicine, Antalya-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2023 Feb;29(2):212-217. doi: 10.14744/tjtes.2022.09406.
Classifications of nasal fracture are based on clinical findings or radiological findings. The classification systems of nasal fracture usually determine the type of nasal fracture. It is important that a classification gives information about treatment modality and prognosis rather than determining the type of fracture. The objective of this study was to show the effect of the new topographic classification on determining the parameters of prognosis and deciding on treatment modality of the nasal fracture.
We reviewed patients with nasal fracture that was referred from emergency department between December 2018 and September 2020. The views of lateral nasal radiography, the facial view of computed tomography (CT), and/or the views of three-dimensional CT were examined to analyze 120 patients with nasal bone fractures. The length of the nasal bone from the top to the base was divided into equal three levels by two lines perpendicular to the length of the nose. The location of fracture was determined as level I, II, and III, respectively, from caudal part to cranial part of the nasal bone. The demographic features of patients, the side of the fracture, the pattern of fracture, accompanying fractures, and the treatment modality were noted.
The frequencies of location of nasal fractures were 44%, 28%, and 27% at level I, level II, and level III, respectively, in 120 cases. It was an expected result that the frequency of fractures was low in parts with the thick bone. Considering the rates of being bilateral or unilateral, it was found that the frequency of unilateral was higher in group of level I, where the thickness of nasal bone was thin, but it was less in group of level III (p<0.05). Non-depressed/minimal-depressed pattern of fracture in group of level I accounted for 92.6% which was the highest frequency (p<0.05). Depressed/elevated fracture patterns were more common in group of level II (p<0.05). Comminuted pattern was mostly observed in group of level III. The rate of accompanying fractures and the applied treatment modality was consistent with anatomic feature of fracture's level.
We believe that the new topographic classification evaluates the parameters of clinical prognosis such as accompanying fracture, site of fracture and pattern of fracture, and also requirement of closed or open reduction better than other classifications.
鼻骨骨折的分类基于临床发现或影像学发现。鼻骨骨折的分类系统通常决定了鼻骨骨折的类型。重要的是，分类不仅要确定骨折的类型，还要提供有关治疗方式和预后的信息。本研究的目的是展示新的局部解剖分类对确定鼻骨骨折的预后参数和决定治疗方式的影响。
我们回顾了 2018 年 12 月至 2020 年 9 月期间从急诊转来的鼻骨骨折患者。检查了侧位鼻放射摄影、面部计算机断层扫描（CT）和/或三维 CT 的图像，以分析 120 例鼻骨骨折患者。用两条垂直于鼻长的线将鼻骨的顶部到底部分为相等的三个水平，骨折的位置分别为 I 级、II 级和 III 级，从鼻骨的尾部到头部。记录患者的人口统计学特征、骨折侧、骨折类型、伴随骨折和治疗方式。
120 例患者中，I 级、II 级和 III 级骨折的位置频率分别为 44%、28%和 27%。在骨较厚的部位骨折频率较低，这是一个预期的结果。考虑到双侧或单侧的发生率，我们发现，在鼻骨较薄的 I 级组中，单侧骨折的发生率较高，但在 III 级组中则较低（p<0.05）。I 级组中非凹陷/轻度凹陷的骨折类型占 92.6%，频率最高（p<0.05）。II 级组中凹陷/抬高骨折类型更为常见（p<0.05）。III 级组中多见粉碎性骨折。伴随骨折的发生率和应用的治疗方式与骨折部位的解剖特征一致。
我们认为，新的局部解剖分类比其他分类更好地评估了伴随骨折、骨折部位和类型以及闭合或开放复位的要求等临床预后参数。
