Using a Kirschner Wire as an Internal Splint at Nasal Fractures Accompanied with Fractures of Frontal Process of Maxilla or Perpendicular Plate of Ethmoid

ABSTRACT

PURPOSE: In cases where nasal fractures involve frontal process of maxilla or perpendicular plate of ethmoid, 4-5 days of nasal packing may not provide sufficient support for avoiding displacement after packing removal. Therefore a single Kirschner-wire(K-wire) is used as an internal splint when nasal fractures involve the above two areas. METHODS: Thirty five patients were treated during the last 3 practical years with a K-wire pinning according to the anatomic locations of nasal fractures. We performed a retrospective study using 13 nasal fractures out of total 35 patients. Among 13 cases, 10 patients involved frontal process of maxilla, and 3 patients were diagnosed as bilateral nasal side wall fractures accompanied with fractures of perpendicular plate of ethmoid. One patient in the last three cases had been augmented with dorsal silicone implant long before the trauma. We analyzed the anteroposterior displacement of key stone area and the width between both lateral walls by comparing immediate postoperative radiographs with 2 month follow-ups. To reduce the errors, the same measurements were taken by two different inspectors, and the mean of each inspector's measurements was compared. Patient satisfaction was analyzed using a questionnaire regarding the esthetic and functional outcomes. RESULTS: Ten patients underwent a longitudinal K-wire fixation in submucoperiosteal plane underneath the frontal process of maxilla. And three patients underwent a transverse K-wire fixation from the one side of lateral wall to the perpendicular plate of ethmoid and to the other side of lateral wall. The mean postoperative anteroposterior displacement of the key stone area measured by two inspectors were 1.84% and 3.06%; mean narrowing of bony pyramid were 1.33% and 1.48%, respectively. Subjective satisfaction scores regarding the esthetic appearance and the maintenance of nasal shape compared with immediate post-operative state with the long term ones were not different(p>0.05). CONCLUSION: K-wire pinning after closed reduction is a reliable and useful method for the treatment of nasal fractures involving frontal process of maxilla or perpendicular plate of ethmoid. This is because it achieves longer intranasal support after reduction. This method also leaves conspicuous external scar, and minimal soft-tissue injury.