The effect of a new topographic classification on determining the prognosis of nasal fracture and treatment modality

BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.

Yeni bir topografik sýnýflandýrmanýn burun kýrýðýnýn prognozunu ve tedavi þeklini belirleme üzerindeki etkisi

AMAÇ: Burun kýrýðýnýn sýnýflandýrýlmasý klinik bulgulara veya radyolojik bulgulara göre yapýlýr. Burun kýrýðýnýn sýnýflandýrma sistemleri genellikle burun kýrýðýnýn tipini belirler. Bir sýnýflandýrmanýn kýrýðýn tipini belirlemekten çok tedavi þekli ve prognozu hakkýnda bilgi vermesi önemlidir. Bu çalýþmanýn amacý, yeni topografik sýnýflandýrmanýn burun kýrýðýnýn prognoz parametrelerini belirleme ve tedavi yöntemine karar verme üzerindeki etkisini göstermektir. GEREÇ VE YÖNTEM: Aralýk 2018 ile Eylül 2020 arasýnda acil servisten sevk edilen burun kýrýðý olan hastalarý incelendi. Lateral nazal radyografi görüntüleri, bilgisayarlý tomografi (BT) yüz görünümü ve/veya üç boyutlu bilgisayarlý tomografi (3D) görüntüleri BT) burun kemiði kýrýðý olan 120 hastayý analiz etmek için incelendi. Burun kemiðinin kraniyalden kaudale olan uzunluðu, burun uzunluðuna dik iki çizgi ile eþit üç seviyeye bölündü. Kýrýk yeri nazal kemiðin kaudal kýsmýndan kraniyal kýsmýna kadar sýrasýyla seviye I, II ve III olarak belirlendi. Hastalarýn demografik özellikleri, kýrýðýn olduðu taraf, kýrýðýn paterni, eþlik eden kýrýklar ve tedavi þekli not edildi.
BULGULAR: Yüz yirmi olguda nazal kýrýklarýn yerleþim sýklýðý I. seviye, II. seviye ve III. seviyede sýrasýyla %44, %28 ve %27 idi. Kalýn kemik kalýnlýðý olan seviyelerde kýrýk sýklýðýnýn düþük olmasý beklenen bir sonuçtu. Ýki taraflý veya tek taraflý olma oranlarýna bakýldýðýnda, nazal kemik kalýnlýðýnýn ince olduðu seviye I grubunda unilateral görülme sýklýðýnýn daha yüksek, seviye III grubunda ise daha az olduðu bulundu (p<0.05). Seviye I grubunda depresif olmayan/minimal depresif kýrýk paterni %92.6 ile en yüksek orana sahipti (p<0.05). Depresif/eleve kýrýk paterni seviye II grubunda daha yaygýndý (p<0.05). Parçalý patern en çok seviye III grubunda gözlendi. Eþlik eden kýrýk oraný ve uygulanan tedavi þekli kýrýk seviyesinin anatomik özelliði ile uyumluydu. TARTIÞMA: Sonuç olarak, yeni topografik sýnýflamanýn, eþlik eden kýrýk, kýrýðýn tarafý ve kýrýk paterni gibi klinik prognoz parametrelerini ve ayrýca kapalý veya açýk redüksiyon gerekliliðini diðer sýnýflamalara göre daha iyi deðerlendirdiðini düþünüyoruz.