(404) Comparative Outcomes of Open Versus Closed Nasal Fracture Reduction in a Propensity-Matched Cohort

Introduction: Nasal fracture is the most common facial skeletal injury, yet comparative data on postoperative outcomes following open versus closed reduction remain limited. This study evaluates one-year infectious, structural, and functional complication rates between open and closed nasal fracture reduction using a large, multi-institutional database.

Methods: This retrospective cohort study used the TriNetX Global Collaborative Network to identify adults undergoing open or closed nasal fracture reduction between 2005 and 2025 across multiple institutions. Patients were identified by CPT codes, and the index event was defined as the first fracture repair; patients undergoing both procedures within 1 year were excluded. Outcomes within one year included chronic sinusitis, facial cellulitis, iatrogenic nasal deformity, and chronic nasal obstruction. Cohorts were matched 1:1 by age, sex, race, diabetes, asthma, substance use disorder, tobacco use, COVID-19 status, and corticosteroid exposure, yielding 4,525 patients per group. Comparative analyses included incidence estimates, hazard ratios with 95% confidence intervals, and Kaplan–Meier survival with log-rank testing.

Results: After propensity score matching, 9,050 patients were included in the final analysis. Compared with closed reduction, open reduction was associated with significantly higher one-year complication rates, including chronic sinusitis (2.6% vs. 1.3%; HR 1.93, 95% CI 1.39–2.69; p< 0.001), facial cellulitis (0.6% vs. 0.2%; HR 2.54, 95% CI 1.23–5.24; p=0.009), iatrogenic nasal deformity (4.6% vs. 3.0%; HR 1.51, 95% CI 1.17–1.94; p=0.001), and chronic nasal obstruction (1.5% vs. 0.9%; HR 1.52, 95% CI 1.03–2.27; p=0.036). Kaplan–Meier analyses demonstrated early and sustained divergence in event-free survival, favoring closed reduction across all outcomes.

Conclusions: Open nasal fracture reduction is associated with a 1.5–2.5-fold higher risk of postoperative morbidity compared with closed reduction. When feasible, closed reduction is associated with superior event-free survival and lower long-term complications.