nasal fracture open reduction and internal fixation ORIF Nasal Fracture (broken nose)

Learn about nasal fractures and broken noses that require an open reduction and internal fixation. Then explore rhinoplasty, nasal surgery, & sculpture of the nose by Dr. Michael Bermant, MD plastic & cosmetic surgery.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

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Nasal Fractures That Need an Open Reduction and Internal Fixation

Most nasal fractures are treated with a closed reduction. The bones are moved without opening the skin. The bones are then externally fixed with a splint. Occasionally an internal splint or packing is used to help with septal injury or bleeding.

Rarely the fracture is severe enough to need an internal repair. Such fractures often are part of other facial fractures or lacerations (wounds). Internal fixation means that the broken bone fragments are held together with wire or other suture, screws and or plates. This type of surgery is more complex than a closed reduction and is often done in the operating room under general anesthesia.

An unstable open nasal fracture (with laceration)

open nasal fracture nasal fracture ORIF 2 nasal fracture ORIF x ray nasal fracture wire reduction

The deformity

X Ray

X rays showing multiple bone fragments

Wires can hold the multiple fragments in place

This patient had laceration and severe nasal fracture that was too unstable for splinting alone. Stainless steel wires were used to hold the bone fragments together. We now occasionally use tiny plates and screws for the more severe nasal fractures. The smallest of the plates and screws measure 1 mm. Plates, screws and wires are more likely to be felt through the skin after healing. They are rarely seen. In most cases they can be left in after surgery although there is a risk of long term infection or loosening. Removal means opening the incision or making a new one.


Titanium plates and screws

The smallest size shown are 1 mm, which can be very valuable in severe nasal fractures.

plates and screws for fractures

Putting these tiny fragments together is often like working with a jigsaw puzzle with missing pieces. I sometimes feel like "all the king's men" putting "Humpty Dumpty together again." To play on these words I used some of the first very tiny plates to "repair" a robin's egg. I also "fixed" some Channel cosmetics with the newer titanium plates for some "cosmetic surgery".

Rhinoplasty Nasal Surgery Important Information

Learn more about rhinoplasty surgery of the nose

Open Rhinoplasty - Photographic details during surgery of the Black nose (warning graphic pictures).

Open Rhinoplasty - Pictures of dorsal and tip sculpture during surgery (warning graphic photographs)

Patient Pictures before and after surgery

Rhinoplasty Experiences Discussions, Forum, and Chat

Nasal Obstruction Septoplasty and Other Nose Discussion Groups, Forum, and Chat

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Basic information about Nasal Fractures - more cases part 2


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This page last updated on: April 21, 2012

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