2.  22yo M presents after
getting elbowed in face
during basketball game. Hx
of nose bleed now
controlled. C/O localized
pain but denies visual
changes or facial numbness.
 T 98 HR 90 BP 140/80 RR 16
PO2 100% RA
 Gen:NAD, dried blood on
face and shirt
 HEENT: PERRLA, EOMI,
deformity and swelling
around nasal bridge which
is TTP, normal nasal
septum, blood in nares,
periorbital echymosis b/l,
remainder of exam wnl

4. 1.Arrows: Lucent line=nasal fracture
2.Star: Fracture with deviation to right

5. Clinical Diagnosis
 Imaging used to r/o associated injuries
Minimally displaced/ non-displaced Fx
 Imaging to r/o associated injuries.
 Ice for 24-48hrs
 Analgesia
 Nasal Decongestant
 Protection
 Elevate Head
 F/U in 1 week
Severe Displacement
 ED consult for possible re-alignment

6.  Waters View
 Posteroanterior position
 Marked deviation, displacement with sharp angulation, and soft-tissue




swelling=possible fx
Lateral View
 Fxs often transverse
 Short lucent lines in nasal anterior cortex=fracture
Septal Hematoma
 Air Zone shapes may be altered
 Important on clinical exam because requires I and D with packing to
prevent necrosis/abscess
Old Fractures
 Only 15% heal by ossification=false positive
CT Face
 Sensitivity of plain films between 50-90%
 CT when concern for other head or facial trauma

8. Tintanelli’s Emergency Medicine: A
Comprehensive Study Guide. Chapter 257
Maxillofacial Trauma
Mettler. Essentials of Radiology. 2nd edition.
Facial Fracture Chapter
Haraldson, S.Nasal Fracture Chapter. Medscape
www.drdavidson.ucsd.edu