Management of Nasal Fractures in Sports

A Thirteen-Year Analysis of Facial Fractures among Professional Soccer Players

This study aims to identify the epidemiology and effects of facial fractures on return to play (RTP) in Major League Soccer (MLS) and the English Premier League (EPL). A total of 39 MLS players and 40 EPL players who sustained facial fractures from 2007 to 2019 were identified. Data on player demographics, the injury, and the impact of their injury on RTP were collected. Elbow-to-head was the most common mechanism of injury (20.3%). The most common fracture involved the nasal bone (48.3%). Most players (90%) RTP the same season. Players who sustained nasal fractures missed significantly fewer games (p < 0.001) than those who suffered other craniofacial fractures. Players treated surgically missed significantly more games (3.21 vs. 0.71, p = 0.006) and days (30.1 vs. 8.70, p = 0.002) than those managed nonoperatively. Significantly more EPL players who sustained facial fractures wore headgear upon RTP compared to MLS players (82% vs. 56%, p <0 .01). Most professional soccer players who sustain a facial fracture RTP the same season, but their recovery time can vary depending on the type of fracture, injury management, or injury severity. Our findings can help inform future craniofacial injury management as well as guidelines on player safety and fracture prevention.

Nasal Injuries and Issues in Athletes

ABSTRACT

Nasal injuries and issues are widespread in athletic populations and can adversely affect training, performance, and overall well-being. Causes can typically be understood as cellular (allergic, nonallergic, and infectious rhinitis) or structural (static vs dynamic obstruction, trauma), and diagnosis and management differ accordingly. Upper respiratory tract infections, a subtype of infectious rhinitis, remain the most common illnesses among athletes. Here, the authors review the research surrounding the complex relationship between exercise, immunology, and susceptibility to infection. Furthermore, the authors provide an updated understanding of the current literature surrounding rhinitis and nasal trauma management and synthesize practical treatment considerations for providers caring for athletes at all levels.

A Novel Balloon Catheter Dilation Apparatus for the Treatment of Depressed Nasal Bone Fracture

The nasal bone fracture is the most common type of facial bone fracture. Closed reduction with metal reduction instrument is commonly conducted for the treatment of a depressed nasal bone fracture which often leads to iatrogenic injury. In this article, a new balloon catheter dilation apparatus for nasal bone fracture is hypothesized by the authors. This device aims to repair nasal bone fracture via dilated balloons under fractured nasal bone and used as nasal internal packing system after operation. Compared with the conventional approach, it is proposed that this balloon dilation apparatus could be a potential powerful, less invasive approach to treat depressed nasal bone fractures.

A Simple and Minimal Invasive Method in Reduction of Depressed Nasal Bone Fracture by Using a Foley Catheter Ballooning Technique

The nasal bone fracture is the most common type of facial bone fracture. Closed reduction with metal reduction instrument is commonly conducted for the treatment of a type II nasal bone fracture. The authors defined a new catheter dilation technique and used it in patients with type II depressed nasal bone fractures. Preoperative and postoperative nasal appearance and radiologic examination of the patients were compared. There was a statistically significant improvement in the nasal appearance of all patients. No recurrence or dorsal irregularity has been observed. This new, easily applicable catheter dilation method of closed reduction may be a simple and less invasive solution to treat type II nasal bone fractures.

Facial Trauma Patterns Among Young Athletes

Study Design

Retrospective case series review.

Objective

Participation in athletics is common in high school and college students and presents an increased risk of injury in this age-group. Previous studies have included National Collegiate Athletic Association athletes but not high school athletes. Here we report the trends of maxillofacial injuries in high school students.

Methods

Patients presenting to a level 1 trauma center with maxillofacial injuries were identified by chart query with associated International Classification of Diseases, 10th Revision codes for facial fractures between October 2015 and October 2017. Data collected included age, sport, fracture type, need for surgery, associated concussion, and time to return to play were measured. New York State Public High School Athletic Association regional high school sports participation data from 2016 to 2018 were used to calculate incidence.

Results

A total of 33 patients aged 13 to 19 years were identified. Baseball, basketball, and lacrosse were most frequently associated with maxillofacial trauma. Annual incidence rates for mandible fractures in high school athletes were 0.037%, 0.012%, and 0.01% for lacrosse, baseball, and basketball, respectively. Annual fracture incidence rates for midface fractures in high school athletes were 0.17%, 0.018%, and 0.01% for baseball, lacrosse, and basketball, respectively.

Conclusion

Maxillofacial fractures are uncommon injuries among athletes but present with serious implications including surgical correction. Baseball was strongly associated with midface fractures despite being considered a noncontact sport. Improved facial protection across all sports will be imperative at reducing the incidences of these injuries.

Level of Evidence

Level 4.

Sport and Recreational Causes of Nasal Bone Fractures

OBJECTIVE

Nasal bone fractures are the most common facial bone fractures. However, there is limited literature on the etiology of these fractures, particularly distribution across sports and other recreational activities.

METHODS

The Nationwide Electronic Injury Surveillance System (NEISS) national injury database was queried for emergency department visits involving the diagnosis of nasal or nose fractures associated with sports and recreation activities over the most recent 10 year span available. Demographic, disposition, and weighted incidence were analyzed.

RESULTS

Total incidence of nasal fractures across 10 years was 158 979. The mean age of nasal bone fractures was 20.4 years old. Nasal fractures were more common in males (74.6%) and white patients (54.1%). National estimated incidence of nasal fractures decreased from 21 028 in 2009 to 11 108 in 2018, a reduction of 47.2%. The most common causes among all patients were basketball (23.2%), baseball (17.1%), softball (9.8%), soccer (7.4%), and football (7%). In pediatric patients, the most common cause was baseball (25.1%). The majority (98.1%) of patients were discharged from the emergency department, while 0.9% of patients were admitted.

CONCLUSION

The most common recreational causes of nasal fractures are sports, with the most common being non-contact sports like basketball and baseball. However, the incidence of nasal bone fractures due to recreational causes nationwide has decreased significantly over the past 10 years. This may reflect improved safety protocols among athletes.

Field Management of Facial Injuries in Sports

This study reviews the epidemiology, diagnostic heuristics, and field management of sports-related facial injuries for sideline physicians.Facial injuries account for 3% to 29% of sports injuries, and sports injuries account for 11.3% to 42.1% of facial fractures. In a previous series, fractures of the nasal bone were the most common in all sports (40%-60.5%); mandibular fractures were common in martial arts (33.3%) and soccer (11.1%), orbital bone fractures were common in basketball (20.0%), ice sports (18.2%), and baseball (15.8%), and fractures of the zygoma occurred frequently in martial arts (13.3%) and soccer (10.0%).Facial lacerations may injure nerves (facial and trigeminal), salivary ducts (parotid or submandibular), and the lacrimal apparatus. Facial fractures are inspected by palpating the bony prominences bilaterally. For simple lacerations, if the player does not have to return to the court, the wound should be cleansed as needed, and surgical adhesives can be applied in the field. However, if return to play is an issue, sutures are recommended rather than surgical adhesives.For nasal injuries involving a gross deformity, immediate closed reduction may not be necessary unless airway competency is compromised. Severe cases of nasal fracture treated immediately by closed reduction should be evaluated by a trained plastic surgeon.In sports, facial injuries are prone to be missed, but their importance should not be neglected. Therefore, sideline physicians should be aware of the relatively high frequency of facial injuries, including facial bone fractures. They should have the knowledge needed to manage these injuries, and must prepare emergency management kits.

Demographic Factors of Nasal Bone Fractures and Social Reflection

INTRODUCTION

The nose is the most protruding central part of the face, and nasal bone fractures are the most common of facial bone fractures, leading up to 39%. Despite its high frequency, not many studies handled the etiology of nasal bone fractures, leading to the necessity of a recent demographic study.

MATERIALS AND METHODS

A total of 1111 patients diagnosed with nasal bone fracture from 2013 to 2018 at our institute were evaluated. A retrospective review of the various demographic and etiologic characteristics was done.

RESULTS

Numerous factors associated with nasal bone fractures were analyzed. Male patients were 3.3 times greater than the number of female patients, and twenties were the most common age range. Violence was the overall most common cause of injury, while slip down was the most common cause for females. Upon monthly distribution, the highest incidence of nasal bone fractures occurred in September, followed by March and December. The authors further divided the patients by time zone of the fractures, and male patients were most commonly injured from midnight to 3 AM, while female patients were 6 PM to 9 PM.

CONCLUSION

Our findings represent a recent urban data of various etiologic factors of nasal bone fracture. The concept of school violence has been widely used since 1990s, and our data reflects that violence of the youth is a serious issue of the society. The mechanism of injury differed among sexes and age groups, and such discrepancies will aid physicians to better understand facial bone fracture patients and educate them in the future.

Early return to sport post maxillofacial fracture injury in the professional athlete: A systematic review

INTRODUCTION

To summarize the current literature on return to sport times post-maxillofacial fracture injury in the professional athlete.

MATERIALS AND METHODS

A literature search on six databases for articles relating to maxillofacial fractures, professional athletes, and return to sport times. Study design, clinical data, and author recommendations were analysed.

RESULTS

17 studies were retrieved. One prospective study returned 17 athletes to competitive rugby union and soccer at 3 weeks post injury without complication. Two large retrospective studies (n = 278) returned patients to sport at approximately 7 weeks without complication. 64% (n = 7) of patients from case based studies returned to sport at 3-14 days, 4 of which utilized protective facemasks. Athletes generally returned to competition earlier for lower grade (3-10 days) compared to higher grade contact sport (21 days at least). 2 articles recommended a 3 months recovery period for combat sports. 8 articles supported the utility of protective facemasks.

CONCLUSION

Early return to sport (<6 weeks) in the professional athlete post maxillofacial fracture injury is achievable. The optimal clinical approach may be to grade the sport according to its impact forces, discuss an early return with reference to the available literature, the potential utility of facemasks, risks of refracture and its operative implications.