Publication:

Predictors of functional and aesthetic failure following closed reduction of nasal fractures: a prospective cohort study

Background Closed reduction (CR) is the standard intervention for nasal fractures, yet historically high failure rates persist. This prospective study aims to analyze clinical outcomes, complication rates, and predictors of surgical failure following CR utilizing validated patient-reported outcome measures (PROMs).

Methods A prospective cohort study of 185 patients undergoing CR for isolated nasal bone fractures was conducted from May 2024 to May 2025. Outcomes were assessed pre-operatively and at 6 months using the nasal obstruction symptom evaluation (NOSE) and standardized cosmesis and health nasal outcomes survey (SCHNOS) scales. Surgical failure was defined as moderate-to-severe persistent obstruction (NOSE>30), significant aesthetic dissatisfaction (SCHNOS-C), or the necessity for secondary Septorhinoplasty. Multivariate logistic regression identified independent risk factors for failure.

Results CR resulted in significant improvement in mean NOSE and SCHNOS scores at 6 months (p 7 days (aOR=2.45, p=0.04) and concomitant cartilaginous septal deviation (aOR=3.61, p=0.01) were robust independent predictors of functional and aesthetic failure. Complication rates were minimal (3.24%).

Conclusions While CR is a safe primary treatment, prospective PROM integration reveals a failure rate of approximately 15%. Unaddressed cartilaginous septal trauma is a primary driver of these failures. Patients with endoscopic evidence of septal deviation should be counseled regarding the high risk of CR failure and considered for primary open reduction or early functional Septorhinoplasty.