title: Reduction of nasal fractures under local anaesthesia: an acceptable practice?
abstract: Nasal fractures are among the most common bony injuries and are among the most frequent reasons for referral to Otorhinolaryngology departments resulting in significant pressure on clinical resources. We present our experience of a Nasal Fracture Clinic dedicated to the assessment of nasal injuries. A prospective study has been undertaken using questionnaires regarding patient satisfaction and acceptability of manipulation under a local anaesthetic (LA). During our three-month study period 91 new patients with nasal injuries were seen; 43 patients were diagnosed to have a displaced nasal fracture requiring reduction. Reduction of the nasal fracture under LA was performed in 37 patients. We found that manipulation under LA was preferred by 94% of patients over the age of 14 years. We achieved a high patient satisfaction rate (80% after three months). The discomfort associated with reduction under LA did not exceed that of a minor dental procedure. No significant complications were encountered during the study period. We conclude that reduction of nasal fractures under LA is a safe and attractive alternative to reduction under a general anaesthetic (GA) and frees-up valuable clinical resources.
authors.affiliation: Department of Otorhinolaryngology, Leicester Royal Infirmary, Leicester, UK.
authors.forename: D C
authors.initials: DC
authors.lastname: Wild
authors.forename: M A
authors.initials: MA
authors.lastname: El Alami
authors.forename: P J
authors.initials: PJ
authors.lastname: Conboy
mesh_terms: D000293:Adolescent; D000328:Adult; D000772:Anesthesia, Local / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D019538:Health Care Surveys; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008485:Medical Audit; D026201:Musculoskeletal Manipulations / Q000379:methods*; D009295:Nasal Bone / Q000293:injuries*; D010147:Pain Measurement; D017060:Patient Satisfaction; D012189:Retrospective Studies; D018570:Risk Assessment; D012887:Skull Fractures / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome