Nasal bone fractures in children and adolescents. Evaluation of plain film radiography as a diagnostic method to determine treatment tactics
RSU MF studentu Marka Roņa un Lindas Veideres pētījums. Uzstājās Rīga Stradiņš University Student International Conference "Health and Social Sciences" 2015 un 3rd International Helath Sciences Conference Lietuvā.
Published on: Mar 5, 2016
Transcripts - Nasal bone fractures in children and adolescents. Evaluation of plain film radiography as a diagnostic method to determine treatment tactics
NASAL BONE FRACTURES IN CHILDREN AND
ADOLESCENTS. EVALUATION OF PLAIN FILM
RADIOGRAPHY AS A DIAGNOSTIC METHOD
TO DETERMINE TREATMENT TACTICS
Marks Ronis, Rīga Stradiņš University, Latvia.
Linda Veidere, Rīga Stradiņš University, Latvia.
Jānis Sokolovs, MD, Children’s Clinical University Hospital, Latvia
• In paediatric population nasal bones are the second most common site of
fractures in the maxillofacial area.1
• In adolescence, a nasal bone fracture pattern more closely follows that of
• Nasal fractures are less common in very young children mostly due to
underdeveloped nasal bones and other factors.1
• In previous studies on nasal bone fractures, a pediatric population was
seldom investigated as a separate group.1
1. Lee DH, Jang YH. Pediatric nasal bone fractures: Does delayed treatment really lead to adverse outcomes? Int
J Pediatr Otorhinolaryngol. 2013 May.
• If an uncomplicated nasal fracture is suspected, plain film radiography is
• Plain radiography will not allow identification of cartilaginous disruptions,
and physicians may misinterpret normal suture lines as nondisplaced
• The sensitivity and specificity of plain radiography in the diagnosis of nasal
bone fracture is 72% and 73% respectively.3
• Despite these facts ordering nasal bone radiographs is an everyday practice
in Children’s Clinical University Hospital, Latvia.
2. Kucik CJ, Clenney T, Phelan J. Management of Acute Nasal Fractures. Am Fam Physician. 2004 Oct 1.
3. Mohammadi A, Ghasemi-Rad M. Nasal bone fracture--ultrasonography or computed tomography? Med Ultrason.
• Evaluate wether the plain film radiography is a necessary diagnostic
procedure in children presenting with nasal trauma to determine
• Identify risk groups for nasal bone fractures in pediatric population.
Materials and Methods
• Using retrospective study design records of 153 patients admitted to
the Children's Clinical University Hospital Otolaryngology department
with the diagnosis „Fracture of nasal bones” S02.2 (ICD-10 ) from
01.01.2012. to 31.12.2014. were studied and data was gathered.
• Statistical analyses were performed using SPSS software and p<0,05
was considered statistically significant.
• Cross tabulation with chi-squared test was used to evaluate the impact
of plain x-ray imaging results on the decision for surgical reduction of
Reduction of the
Not confirmed 4 34 38
Confirmed 7 85 92
Total 11 119 130
Reduction of the
Yes 2 112 114
No 2 7 9
4 119 123
13 and older
Fight with criminal character
Fight without criminal character among peers
• Over the course of 3 years at least 272 (136) lateral nasal bone
radiographs have been done.
• The government pays 4,15 Eur (2,92 Ls) per patient.
• That makes it 564,4 euros in total.
• For a method that is 72% sensitive and 73% specific.3
• Doctors admit that even in cases where the nasal bone fracture is
evident on physical examination, parents are those who often
demand x-rays before reduction of the fracture.
3. Mohammadi A, Ghasemi-Rad M. Nasal bone fracture--ultrasonography or computed
tomography? Med Ultrason. 2011 Dec.
• Computer tomography (CT) is a great alternative for detecting nasal bone fractures
with sensitivity an specifity near 100%, but CT has lower accuracy in low grade
• Ordering a CT scan for children often means genera anesthesia, and there are
issues with the availability of this type of study.
• The risks of radiation-induced leukemia and brain cancer are highest for head
scans, which are the most commonly performed CT scans in pediatrics.4
• High-resolution ultrasonography (HRUS) on the other hand is 97% sensitive and
100% specific and is radiation free.3
3. Mohammadi A, Ghasemi-Rad M. Nasal bone fracture--ultrasonography or computed tomography? Med Ultrason. 2011 Dec.
4. Miglioretti DL, Johnson E, Williams A. The Use of Computed Tomography in Pediatrics and the Associated Radiation Exposure and
Estimated Cancer Risk. JAMA Pediatrics 2013 Aug.
• Based on the descriptive statistics a risk group of nasal bone fracture
patients in pediatric population can be outlined – teenage boys who do
• It should be identified in future studies what causes this high trauma risk –
physical imaturity, strive for victory by all means or the fact that coaches
don’t spend enough time teaching children about personal safety in sports.
• Plain film radiography is unreliable for the evaluation of nasal bone fractures
• Furthermore it’s results are often not taken in account or have no impact
when deciding for the reduction of the fracture.
• The decision for surgical reduction can be based on the results of a
thorough patient examination and the fact that the patient presents with a
visual deformity of the nose.
• If graphic confirmation of the fracture is needed, HRUS of nasal bones
should be considered.