Comparative Analysis of Open and Closed Nasal Fractures in Trauma Settings: Mechanisms, Intent, Surgical Interventions, and Outcomes

Abstract

Background Nasal fractures, one of the most common facial injuries in trauma settings, present diverse challenges in terms of diagnosis, management, and prognosis. Understanding the mechanisms of injury, intent, procedural interventions, and mortality outcomes is crucial to enhance patient care and develop preventive strategies. This study aimed to analyze the patterns and trends in nasal fractures, categorizing them by mechanism and intent, examining the range of procedural interventions, and assessing mortality rates. The goal was to provide a comprehensive understanding of nasal fractures in trauma settings to inform clinical practice and prevention efforts. Methods This retrospective analysis was conducted using trauma data from 2013 to 2016. Nasal fractures were classified into closed and open types and the mechanisms of injury were categorized. The intent behind the injury was also classified. Procedural interventions, including turbinectomies, septoplasties, and nasal fracture reduction, were compared between the two fracture types. Mortality rates were calculated and analyzed year-wise. Results This study analyzed 122,574 closed and 9,704 open nasal fractures to elucidate the demographic, hospital, procedural, and clinical characteristics. Significant risk factors for open nasal fractures included higher Injury Severity Score (OR 1.004 per point, 95% CI 1.002-1.006), self-inflicted intent (OR 2.157, 95% CI 1.855-2.509), unintentional causes (OR 2.166, 95% CI 1.964-2.388), and firearm mechanism (OR 8.839, 95% CI 7.287-10.722) compared to assault injuries. Open fractures underwent more operative interventions such as nasal fracture reduction and nasal plastic repair. Patients with closed fractures underwent more operations on the nose, mouth, and pharynx. Open fractures had longer median procedure times (18 vs. 8.4 h) but similar lengths of hospital stay. Conclusions Injury severity has emerged as a major predictor of open nasal fractures, with severe multi-trauma substantially increasing the risk. This national analysis informs prevention priorities, resource planning, and risk screening to improve the management of complex facial traumas within the US trauma system.