Broken nose (nasal fracture)
A broken nose (nasal fracture) usually occurs from an athlete getting hit in the face by either an opponent or sports equipment such as hockey sticks, baseballs, or softballs. Fractures can occur either from a direct blow to the front of the nose or from a sideways blow.
Who gets a broken nose (nasal fracture)?
A broken nose (nasal fracture) is common in sports where there is direct physical contact between athletes. A broken nose is common in the sports of basketball and soccer from head-to-head contact, head-to- elbow contact, or head-to- shoulder contact.
Any sport in which a small ball is flying at high speeds is a sport in which a broken nose is common. For example, take the sport of softball. Fractures can occur in a number of ways including fouling off an inside fastball or curveball directly to the nose, taking a grounder off of a bad hop directly to the nose, or missing a fly ball with the glove and catching it with the nose.
What are the signs and symptoms of a broken nose?
Most broken noses are going to immediately result in nasal bleeding. The blood can be coming from both the inside of the nose from the fracture and outside of the nose from lacerations and/or abrasions incurred during the impact.
One of the best indicators of a broken nose is the alignment of the nose. Have the athlete look into a mirror as soon after the impact as possible and prior to the swelling setting in. Have the athlete check the bridge of the nose to see if it looks straight.
The nose may also look flattened or asymmetrical. The nasal airway may be obstructed making it difficult for the athlete to breathe through both nostrils.
As time passes, the tissue around the nose and below the eyes will begin to swell. Discoloration will also begin to set in and will increase in color during the 48 hours post-injury.
What is the immediate treatment for a broken nose?
If the athlete is conscious and bleeding, the first step is to stop the bleeding. Gauze can be applied to the nose with mild pressure. The athlete should be placed in a sitting position with their head tilted forward. This will cause the blood to drain out of the nose and not down the back of the athlete’s throat.
If the athlete is conscious and is lying on the ground and bleeding, gently roll the athlete on to his/her side to allow the blood to drain out and onto the ground. If a neck or serious head injury is suspected, leave the athlete in the position that you find him/her and call emergency medical services.
Once the gauze is in place, determine if the athlete has any signs and symptoms of concussion. Check for the following:
• Ringing in the ears
• Inability to answer simple questions
If any of the above symptoms are present, continue assisting the athlete and call emergency medical services.
Once the bleeding has stopped, a small ice pack can be applied to the nose and face to reduce the swelling. If a fracture is suspected, the athlete should be transported to a local hospital for x-rays and a thorough medical evaluation.
Should I have the broken nose reset?
If a broken nose is present, the athlete may have his/her nose repositioned if needed by an emergency room physician or may be referred to an ear, nose, and throat specialist. To have the fracture repositioned without surgical repair, this should be done either immediately after the injury or 3 to 7 days later when the swelling has reduced.
If significant time has passed and the fracture has begun to heal (7 days post-injury), then surgical repair may be required to reset the fracture.
Is it safe to return to sports after a broken nose?
Athletes can safely return to sport when they have been cleared by a physician to return and only if they wear a protective splint or face guard. These can be purchased by sports medicine companies or can be custom made for the individual. The athlete should wear the face guard for at least six weeks post-injury or until the physician states that it is safe.
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- Anderson, M.K., Hall, S.J., & Martin, M. (2009). Foundations of Athletic Training: Prevention, Assessment, and Management. (3rd Ed). Lippincott Williams & Wilkins: Philadelphia, PA
- Bahr, R., & Maehlum S. (2004). Clinical Guide to Sports Injuries. Human Kinetics: Champaign, IL.
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