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Best Evidence Topic reports
BET 4: SHOULD NASAL FRACTURES BE MANIPULATED UNDER LOCAL ANAESTHESIA?
  1. Oisin Powell,
  2. Deepak Doshi, Specialist Registrar in Emergency Medicine
  1. Cork University Hospital, Ireland

    https://doi.org/10.1136/emj.2008.063412

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      Report by Oisin Powell

      Checked by Deepak Doshi, Specialist Registrar in Emergency Medicine

      Institution: Cork University Hospital, Ireland

      THREE-PART QUESTION

      In [adults with displaced nasal fractures] does [digital manipulation under local anaesthesia vs manipulation under GA] produce [cosmetic appearance and airway patency comparable to manipulation under general anaesthesia, at acceptable pain levels for the patient].

      View this table:
      Table 1 Relevant papers

      CLINICAL SCENARIO

      A 24-year-old patient presents to the emergency department (ED) following an altercation in the street. He has been punched in the nose and clearly has a nasal deformity consistent with a broken nose. There is relatively little soft tissue swelling at this stage. You decide to refer him to the ENT clinic in a week’s time, but a colleague suggests manipulating it in the ED under local anaesthesia and a bit of sedation. You seriously wonder if this is a good idea.

      SEARCH STRATEGY

      Medline/Pubmed online search. Cochrane database online search. NCBI/PUBMED search for relevant articles using the terms “nasal fracture local anaesthesia manipulation”. Cochrane database search for relevant articles using the terms “Nasal fracture”.

      SEARCH OUTCOME

      NCBI/PUBMED search found 18 articles of which 11 were relevant. Cochrane search found 10 articles of which four were relevant.

      COMMENT(S)

      A large prospective randomised trial is needed to assess the reduction outcome of manipulation of the fractured nose under local anaesthesia as compared with general anaesthesia.

      Clinical bottom line

      The evidence available points towards manipulation under local anaesthesia as being a procedure that is acceptable to the patient in terms of pain, cosmetic and functional outcome. A large prospective randomised multicentre trial is required to conclude.

      References

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