Improper Reduction Research Articles

The Periarticular Pelvic Clamp: An Indispensable Aid to Assist in the Narrowing of Facial Width in Mandibular Trauma.

Symphyseal fractures of the mandible with concomitant bilateral condylar fractures can often be a particularly challenging fracture pattern for the facial surgeon. Improper reduction of these fractures may lead to facial widening that proves difficult to correct secondarily. Here the authors describe a method to prevent this unwanted facial widening with the use of an orthopedic periarticular reduction clamp. This method allows for not only increased ease of reduction but also reduces the burden of assistance in manual reduction of the fracture.

Development of a robot-assisted reduction and rehabilitation system for distal radius fractures.

Background: Closed reduction is the preferred treatment for distal radius fractures. However, it requires a multiple experienced medical staff and manually maintaining stable traction is difficult. Additionally, doctors cannot assess the reduction status of a fracture in real-time through radiographic images, which may lead to improper reduction. Furthermore, post-fracture complications such as joint adhesion, stiffness, and impaired mobility pose a challenge for the doctors. So it is necessary to optimize the treatment process of the distal radius fracture through technological means. Methods: A robot-assisted closed reduction and rehabilitation system, which could assist doctors throughout the entire process of reduction, fixation, and rehabilitation of distal radius fractures, was developed. A mechanical system, composed of two grippers and a cooperative robotic arm, was used to grasp and tract the affected limb. A doctor controlled the robot through a joystick console and Windows application program. A biplane radiographic device was integrated into the system, which is not only convenient for doctors to view radiographic images of the fracture at any time but also for them to select the rotation axis of the wrist on the images before reduction and rehabilitation. Important information including the anteroposterior and lateral radiographic data and force and position parameters during the reduction and rehabilitation process were displayed on a graphic user interface. Results: Experimental results showed that the proposed robotic system can meet the technical requirements for the reduction and rehabilitation of distal radius fractures, all the rotation angles could be achieved, a maximum force of more than 50N could be achieved in all traction directions, and the error in selecting the wrist joint rotation axis line using radiographic images was less than 5mm. Conclusion: The developed robot-assisted system was shown to be suitable for closed reduction and rehabilitation of distal radius fractures, contributing a potential improvement in the quality of the procedures.

Blocking screw (pin) technique to achieve an acceptable reduction in intramedullary of subtrochanteric femoral fractures: indications, techniques, and clinical outcomes.

Subtrochanteric femur fractures treated with intramedullary nails present biomechanical benefits, early weight-bearing, and reduced soft tissue damage, promoting bone union. However, improper reduction due to muscular forces and fragmented proximal bone increases nonunion risk. This study evaluates the efficacy of the blocking screw technique in preventing malalignment during intramedullary nailing. In cases of subtrochanteric femoral fractures where malalignment, such as varus and anterior angulation, was anticipated during intramedullary nailing, proper reduction was ensured using blocking screw technique on the proximal bone fragment from the coronal or sagittal plane. A retrospective analysis was conducted on 25 patients (14 males, 11 females; average age 55.12years) who were followed up for more than 1year. The postoperative neck-shaft angle, anterior angulation angle, and limb length discrepancy were compared radiologically with those on the healthy side, and the presence and duration of bone union were measured. The Harris hip score was used for functional evaluation, and complications, including infection, were analyzed. At the final follow-up, primary bone union was achieved in 21/25 patients (84%), with an average bone union time of 21.81weeks (range, 14-42weeks). Of the four nonunions, bone union was achieved in three cases through bone grafting and supplemental plating and in the other case through intramedullary exchange, supplemental plating, and bone grafting. The femoral neck-shaft angle and anterior angulation showed no statistically significant differences compared with the healthy side, with averages of - 1.15° and - 1.4°, respectively. The limb length discrepancy was an average of - 2.4mm. Regarding functional outcomes, the Harris hip score averaged 89.52 points (range 82-94 points). In subtrochanteric femoral fractures, the blocking screw technique effectively prevents malalignment during intramedullary nailing, ensuring not only appropriate reduction but also high bone union rates.

Study of importance of medial cortex in distal femur comminuted fracture

<p><strong>Background:</strong> Distal femur fractures require high energy trauma by means of road traffic accidents. There are various modalities of fixation, involving plating, external fixator and intramedullary nailing. cause of nonunion like smoking, osteoporosis, early weight bearing, improper construction of fixation, improper reduction.</p><p><strong>Methods:</strong> The study was conducted on 20 patients having distal femur fractures operated previously by using a different modality of implant goes in failure like bending of implant, broken of implant, peri implant fracture after second episode of trauma. Patient was preoperatively assessing for rule out occult low grade infection by blood investigation like ESR and CRP. Previous X-ray review to find cause of nonunion.</p><p><strong>Results:</strong> All patients showed a complete union at the fracture site with an average duration of 4-6 months. There was no complaint of infection, joint stiffness or difficulty in weight bearing after treatment with revision fixation and bone grafting. Patients were able to walk without affecting their daily activity of living. </p><p><strong>Conclusions:</strong> Comminuted medial cortex left unfixed or maligned will go into varus collapse and leads to failure of fixation.</p>

Is It Possible to Perform Fifth Carpometacarpal Joint Arthroscopy? Cadaveric Study on Its Feasibility, Safety, and Potential Hazards in Portal Creation.

Background Fifth carpometacarpal joint (CMCJ) fracture dislocation is a relatively rare injury and most will require operative treatment because of its unstable nature. Improper reduction and fixation lead to joint surface destruction, pain, and reduced grasping power. Intra-articular fragment reduction is often obscured by dorsally displaced ulnar fragment. Therefore, fifth CMCJ arthroscopy can be advantageous in assisting intra-articular fragment reduction. However, there is no detailed description of the portal landmarks or portals' relationship with adjacent important structures in the literature. Purposes To explore the feasibility and safety of fifth CMCJ arthroscopy, locations of the portals are examined in cadaveric hand specimens. Their proximity to important anatomical structures such as dorsal cutaneous branch of ulnar nerve (DCBUN), ring finger and little finger extensor digitorum communis (EDC), and extensor digiti minimi (EDM) is measured. Methods Fifth CMCJ arthroscopy is performed on 11 cadaveric hand specimens by specialist-level surgeon. The portals are marked and portal positions are further confirmed under the fluoroscopy. Then the cadaveric specimens were undergone anatomical dissection by specialist-level surgeon. During dissection, the spatial relationship between the portal positions and DCBUN, EDC to ring finger and little finger, and EDM is identified. The distance between the portals and the above important structures was measured in millimeters. Results DCBUN was consistently found between fourth metacarpohamate (4-MH) and fifth metacarpohamate (5-MH) portals, with it being closer to the latter (mean distance, 2.03 mm; range, 0-4.43 mm; standard deviation [SD], 1.09 mm). The closest tendon for 4-MH portal is ring finger EDC (mean distance, 2.65 mm; range, 0-5.89 mm; SD, 1.78 mm), while 5-MH portal and accessory portal were closest to EDC (mean distance, 1.88 mm; range, 0-3.69 mm; SD, 1.25 mm) and EDM (mean distance, 7.79 mm; range, 6.63-10.72 mm; SD, 1.49 mm), respectively. During the process of specimen dissection, we found no damage to the above structures after portal introduction. Conclusion The above findings support the use of fifth CMCJ arthroscopy, which can be used for assisted reduction in fifth metacarpal base fracture dislocation and hamate body fracture. Gentle soft tissue spreading technique during portal creation prevents injury to the important structure surrounding the portals. Level of evidence This is a Level V study.

CT analysis of femoral malrotation after intramedullary nailing of trochanteric fractures.

Functional results after internal fixation of trochanteric femoral fractures may be negatively affected by healing in a non-physiological position. The aim of this study was to evaluate the occurrence and severity of femoral malrotation after nailing of trochanteric fractures. The authors conducted a prospective study focused on a CT analysis of malrotation after intramedullary nailing of trochanteric fractures (AO 31A1-3) in 101 patients. We recorded the type of fracture, method of anesthesia, scheduled surgery vs. acute surgery, and the surgeon's experience as possible risk factors for limb malrotation after trochanteric fracture surgeries. The average extent of malrotation was 9° of internal rotation ranging from 29° of external to 48°of internal rotation. In 35% of patients, we observed a rotation greater than 15°, and in 15 patients (15%), the rotation was greater than 25°. The risk of significant internal malrotation was significantly higher than external malrotation (37 vs. 4 patients). None of the factors observed proved to be statistically significant. The effect of general anesthesia and the type of intertrochanteric fracture came closest to having a significant effect on rotational error. Improper reduction of a trochanteric fracture is a common problem that can lead to femur malrotation. In our study, a rotational error greater than 15° occurred in 35% of the patients, but none of the monitored factors represented a statistically significant risk for this complication.

Fixation of Closed Transverse Patella Fracture with Cannulated Cancellous Screws and Anterior Tension Band Wiring- A Prospective Study

Patella fractures accounts for 1% of all skeletal injuries. Patella fractures usually need to be treated with accurate reduction and fixation to obtain optimal knee function. Improper reduction of the articular fragments leads to complications like arthritis and quadriceps dysfunction. Tension band wiring and pasting are commonly performed fixation methods. Tension band wiring with K-wires is associated with wire prominence and soft tissue irritation. Cannulated cancellous screw fixation of the fracture and tension band wiring through the cannulated screws avoid the complication of wire migration and breakage. In our study, we fixed these fractures with cannulated cancellous screws and tension band. This is a prospective study done in SRMC from 2012-2017. A total of 17 Patients with transverse patella fracture are taken into a study, 4mm cannulated cancellous screws with 18 mm stainless steel wire is used for anterior tension band wiring. Extensor retinaculum closure is done for all these patients. All patients had excellent knee function, according to KSS. There was no case of implant prominence or soft issue irritation in any of these patients. One patient had extensor lag. Cannulated cancellous screw with anterior tension band wiring is a reliable, effective and reproducible technique in treating transverse patella fractures.

Difficulty of Arch Reduction with Gillies Temporal Approach in a Coronoid Hyperplasia Case.

Bilateral coronoid hyperplasia is an abnormal elongation of the mandibular coronoid process which is rare in occurrence and causes progressive but slow reduction in mouth opening. In case of reduction in zygomatic arch fracture by Gillies temporal approach, the presence of bilateral coronoid hyperplasia can be a possible factor for hindrance and improper reduction. We propose a technical note to overcome this hindrance caused by the coronoid hyperplasia and propose tips and tricks to successful reduction in zygomatic arch. Adequate reduction in the zygomatic arch and pretrauma mouth opening was achieved. Manual repositioning of the mandible during Gillies temporal approach along with ultrasound guidance leads to a satisfactory outcome.

Does Intraoperative Computed Tomography Improve the Outcome in Zygomatico-Orbital Complex Fracture Reduction?

Zygomatico-orbital (ZMO) fractures pose considerable difficulty in intraoperative assessment during open reduction and internal fixation (ORIF), and this can be attributed to its three-dimensional complex anatomy and articulations. Recent advancements in the form of intraoperative imaging and navigation have led to an adequate assessment and correct reduction of these fractures minimizing chances of any revision surgery. The purpose of this study was to evaluate the advantage of intraoperative computerized tomography (CT) scan in the management of ZMO/isolated orbital complex fracture and further to develop a protocol for managing such fractures. Twenty-three cases of ZMO/isolated orbital fractures were managed with ORIF, followed by an intraoperative CT scan. The evaluation was focused on the articulations of the zygoma and orbital wall reconstruction. The score of 0 and 1 was given for inadequate and adequate reduction, respectively. Necessary corrections were performed in case of improper reduction followed by a repeat CT scan if required. The reduction score was statistically correlated with number of incisions. In 8 (35%) out of 23 patients, clinical judgment was inaccurate when radiologically assessed with an intraoperative CT scan. In 6 out of 8 cases, a repeat CT scan was done after revision of reduction. The reduction score improved with additional incision and revision in the second CT scan. Intraoperative CT has an important role in assessing the accuracy of reduction and confirming implant position in ZMO/isolated orbital fractures. This can avoid the need for secondary corrective surgery and postoperative imaging. Intraoperative CT is an important tool to improve surgical outcomes in the management of ZMO orbital fractures.

The Use of a Novel CAD-CAM Splint to Simplify Open Reduction and Internal Fixation of Mandibular Angle Fracture: A Technical Note

Mandibular angle fractures are frequently encountered as they constitute an area of weakness. Complications after open reduction and internal fixation (ORIF) of angle fractures commonly arise due to improper reduction and fixation methods that fail to counteract the dynamic muscle forces present in this region. Conventional reduction methods such as digital manipulation, intermaxillary fixation, towel clip traction, and wiring are associated with various limitations. This technical note highlights the fabrication and use of a computer-aided designing/computer-aided manufacturing-generated splint for ORIF of a superiorly displaced mandibular angle fracture. The splint consisted of 2 components: (1) a distal tooth-borne component to guide the teeth into maximum intercuspation and (2) a proximal bone-borne component to reduce the angle fracture. This composite splint facilitates simultaneous restoration of occlusion as well as reduction of mandibular angle fractures. The advantages of this technique include the following: (1) easy fabrication of splint, (2) easy and precise anatomical reduction of angle fracture, and (3) less operative time.

Surgical stabilization of supracondylar fracture femur with locking compression plate: A Study on functional outcome

Fractures of the distal end of femur especially comminuted, intra- articular extension remain some of the most challenging fractures facing orthopaedic surgeons. The present study is justified for the fact that it will be one of the solutions for the age-old complications associated with the treatment of supracondylar fractures with traditional fixed angle plates and nails of, postoperative loss of reduction (varus collapse) and malalignment due to the inherent lack of rigidity and in some cases, eventual implant failure. After the proper preoperative evaluation fitness for surgery was obtained. The limb to be operated was shaved and prepared a day before scheduled surgery. Antibiotic was injected intravenously at least 10 minutes before surgery. Although various approaches like direct lateral-standard approach, minimally invasive lateral approach, medial approach and antero-lateral approach are described however in the current study direct lateral approach was used which is the standard one generally followed by the various previous studies. Out of 30 fractures, 19 fractures accounting for 63.3% were open fractures. Rest of the fractures were closed. In this study majority of the cases 19 (63.3%) were due to road traffic accidents seen in below 50 years of age. Long term results were rated using Neer’s rating system. Neer’s score was assigned for each patient after 24 to 36 weeks. Using this scale 16 cases (53.3%) shown excellent, 11 cases (36.7%) good and 3 cases (10%) poor result. Out of three varus malalignments two were of type C3 fracture and one type C2. Factors contributing to malalignment were severe comminution and improper reduction.

Closed Unassisted Reduction in Emergency: A Technique for Unassisted Closed Reduction of Colles Fractures Without Equipment.

Colles fractures are fractures of the distal radius that are often encountered in the emergency department. They result from accidents and sport injuries in the young but are a common outcome of falls in the elderly population. While Colles fractures are frequently expected to heal with good results, improper reduction, malunion, or later displacement are related to poor functional outcomes in the long term. Treatment is usually by closed reduction either manually or using longitudinal traction. The disadvantage of this is the need for either trained assistants or equipment. We propose a technique for closed unassisted reduction without the use of equipment that can be useful in acute settings where there is shortage of assistance and tools. Fifty-two patients with distal radius fractures were treated with closed unassisted reduction in emergency. The steps of the technique are explained in detail and shown in the accompanying videos. The key lies in the placement of the patient, the use of the doctor's thigh as a lever for the reduction, and positioning of the arm to support the reduction using its own weight. All 52 reductions were successful, while the duration of the reduction process was in all cases under 10min. Closed unassisted reduction in emergency for Colles fractures is a reliable and simple technique, its major advantage being that it can be performed quickly by 1 physician without equipment.

A New Reference to Evaluate Syndesmosis in Sagittal Plane Radiographs of the Ankle: The Lateral Posterior Ankle Ratio.

Confirmation of anatomical reduction of ankle syndesmosis is mandatory because improper reduction leads to poor functional results. Coronal plane evaluation of syndesmosis is well described in the literature, but there is little information about sagittal plane evaluation. We sought to evaluate the relationship of fibula and tibia in the sagittal plane and create a new reference that can be applied easily and reliably. Lateral ankle radiographs of 337 individuals with no history of ankle fracture were evaluated. A line was drawn between the anterior and posterior cortices of the distal lateral tibia, and the length of this line was measured (line 1). The distance between the anterior and posterior cortices of the fibula on this line was measured, and the center of this second distance was identified and marked. The posterior half of the fibular width was divided by line 1 and was named the lateral posterior ankle ratio (LPAR). Statistical analysis was performed by side and sex. Mean patient age was 38.6 years; mean LPAR was 0.48. There was a significant difference between men and women by age (P < .001) and LPAR (P = .01). There was no significant difference between right and left ankles by age (P = .63) and LPAR (P = .64). The LPAR was less than 0.40 in 6.8% of the radiographs, 0.40 to 0.50 in 57.9%, and greater than 0.50 to 0.60 in 32.9%. The LPAR should approximate 50% in normal lateral ankle images and, by extrapolation, after syndesmotic reduction.

Posterior Malleolus Fractures in Trimalleolar Fracture Dislocations of the Ankle Fixed with Anteroposterior Screws vs Posterior Plating: A Clinical Outcome Study

ABSTRACT Introduction Fracture dislocations of the ankle are rare injuries with often poor outcomes due to posttraumatic arthritis and instability of the ankle. A concomitant fracture of the posterior malleolus occurs in 7–44% of all ankle fractures. Aim of the study To study the outcomes in operated cases of posterior malleolus fractures fixed using percutaneous anteroposterior (AP) screws vs posterior buttress plating and to study which is advantageous. Materials and methods Our study was conducted between December 2013 and December 2015. All operated cases of posterior malleolus fractures in trimalleolar fracture dislocations of the ankle joint were included. Polytrauma cases and open injuries were excluded. Among 28 cases, 24 cases were available for final follow-up. The average age was 47.2 years, and road traffic accident was the predominant cause in 80% of the cases. In 9 cases, buttress plating, and in 15 cases, percutaneous AP screws were used as decided by senior surgeon. All cases were followed up at periodic intervals. Mean follow-up is 28.5 months. Results Average union time is 14.2 weeks. Ankle fracture scoring system designed by Phillips et al. was used. The outcome is the sum of the clinical score (follow-up), the anatomical score (postoperative), and arthritis score (follow-up). A minimum score is 0, and the maximum score is 150. In posterior plating group, the average score was 128 out of 150. In AP screws group, the average score was 114 out of 150. Improper reduction and articular step were noticed in three cases and developed ankle arthritis in subsequent radiographs. There were no infections in our series. Conclusion Posterior plating gave better results due to stable anatomical reduction and by early physiotherapy, while AP screws group had relatively moderate outcome due to articular step off and late arthritic changes. How to cite this article Arunkamal C, Dheenadhayalan J, Agraharam D, et al. Posterior Malleolus Fractures in Trimalleolar Fracture Dislocations of the Ankle Fixed with Anteroposterior Screws vs Posterior Plating: A Clinical Outcome Study. J Orth Joint Surg 2019;1(1):11–14.

Distal humeral flexion osteotomy for the treatment of supracondylar extension-type malunions in children.

Distal humeral extension-type malunions may occur as a complication following improper reduction of supracondylar humerus fractures. We evaluated results after distal humeral flexion osteotomies for sagittal realignment of the humeral condyle in children. Medical records and radiographs of all patients younger than 18 years of age, who underwent this procedure because of a clinically relevant lack of elbow flexion, were evaluated. In a cohort of 18 children with a mean age of 8 years at the time of surgery and a mean follow-up duration of 1 year, elbow flexion increased significantly from a mean of 101° preoperatively to 126° at the final follow-up; established radiographic parameters (e.g. anterior humeral line, humerocondylar angle) were normalized as well. The distal humeral flexion osteotomy is a reliable method to efficiently correct extension-type malunions and improve impaired elbow flexion in children.

Development of a novel pediatric forearm fracture treatment: simulation, prototype and evaluation

Abstract A treatment gap exists for moderately displaced pediatric distal forearm fractures (DFF), which carry a potential risk of improper reduction when treated conservatively. Currently, no standard method for the correction of the initial reduction of pediatric DFF is available. A novel closed reduction method has been proposed to correct and maintain a successful reduction throughout the healing process. This study further develops this novel cast system and evaluates its mechanical behavior through the design, construction, and testing of a biomechanical CAD model and pediatric forearm phantom. Initial results support the novel system as an improved treatment for pediatric fractures. Both the CAD model and tissue phantom indicate the ability of the system to manipulate a 15° fracture, with 0-1° of residual angulation.

Comparative study between proximal femoral nail and dynamic hip screw with trochanteric stabilizing plate in unstable intertrochantric femur fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Unstable fractures accounts for approximately 50 to 60% of all intertrochanteric fractures. Failure rates of (DHS) dynamic hip screw for unstable fracture patterns are as high as 50%. Proximal femoral nail is technically more demanding surgery and also associated with complications like implant failure, femoral shaft fracture, improper reduction, screw cut-out and non-union. This study was done to compare the results of using Trochanteric stabilization plate in addition to dynamic hip screw versus proximal femoral nail which is considered as a better implant for unstable fractures.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A prospective study was conducted comparing outcomes of proximal femoral nailing versus trochanteric stabilization plate with dynamic hip screw for 44 patients with unstable intertrochanteric fractures (22 each). Harris hip scoring system and Parker mobility score was used for evaluation&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In our study, Average time of union in all 22 patients of PFN group was about 12 weeks while average time of union in all 22 patients of DHS with TSP group was about 14 weeks. The Harris hip score was 85.45 in DHS with TSP group while it was 84.72 in the PFN group (p=0.846). The Parker mobility score was 7.81 in the DHS with TSP group while it was 7.95 in the PFN group (p=0.728)&lt;/span&gt;&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Use of TSP with DHS can give good results in unstable IT fractures. Addition of TSP to DHS gives good lateral wall buttress which prevent excessive medialisation of shaft and gives comparable result to PFN.&lt;/span&gt;&lt;/p&gt;

Analysis of soft reduction on bloom internal crack by a strain model

ABSTRACTSoft reduction (SR) can effectively improve the strand centre quality by decreasing its porosity and segregation. However, it tends to cause internal crack defects in the bloom if an improper reduction amount or improper reduction zone is implemented on the strand. In this work, a two-dimensional non-steady solidification model and a strain model are established for 350 mm × 470 mm bloom casting. Using the strain model, the strain field for GCr15 bloom upon SR is calculated. Through the online SR test and macrostructure inspection of the cast blooms, the minimum centre solid fraction suitable for SR of the bloom is determined. The results show that the established strain model calculation agrees well with the practical bloom macrostructure inspection. Thus, with the strain model, one can calculate whether internal crack defects would occur, as well as determine the right reduction amount or proper reduction zone.

When the earth shakes … and science with it. The management and communication of uncertainty in the L’Aquila earthquake

In the spring of 2009, a strong earthquake shook the Italian city of L’Aquila and the region surrounding it. Besides the tragedy of human and material losses, the disaster triggered an unprecedented series of legal consequences. In this paper, we take the L’Aquila case, in all its psychological, social and legal controversies as exemplary for reflecting on how uncertainty can be recognized, treated and communicated in the context of mass emergencies. We examine the inherent path-dependency and multidimensional nature of uncertainty by projecting it along a number of axes, analyzing how the different components evolve and interact with each other. We show that contradictions, controversies and conflicts are bound to arise in the practice of expert advice for public policy as a result of: 1) the improper reduction of the overall situational uncertainty to its scientific component only; 2) the treatment and communication of scientific uncertainty as an independent variable that can be analyzed and computed in isolation from ethical, political and societal concerns. Finally, we provide some suggestions about a more integrated approach to expert advice for public policy.

Improving Results in Closed Nasal Reduction: A Protocol for Reducing Secondary Deformity.

Nasal fractures are the most common facial fracture. Improper reduction is a common occurrence, resulting in a residual deformity that requires secondary surgery. A treatment protocol for nasal fracture management is presented with the aim of reducing secondary deformities requiring corrective surgery. After institutional review board approval, a retrospective review of all closed nasal reductions performed by a single surgeon between 2006 and 2015 was conducted. Patient age, sex, presence of secondary deformity, and need for a correctional operation were recorded. Clinical records were analyzed for evidence of postoperative deformity and need for subsequent manipulation or surgery. A total of 90 patients with nasal bone fractures who underwent closed nasal reduction were identified. The mean age of patients was 24.9 years. The male-to-female ratio was 2.2:1. Postoperative deformity was reported in 14 patients (15.6 percent). Four of the 90 patients (4.4 percent) were found to have avulsion of their upper lateral cartilage from the nasal bone. Nine of the 14 subjects (64.3 percent) presenting with secondary deformity were managed with external manipulation, avoiding a secondary operation. Five patients (5.5 percent) from the original cohort of 90 underwent revision surgery. By using the described protocol to treat nasal fractures, we have seen a low rate of postreduction deformity and a small percentage of need for secondary operation. The overall success rate of closed nasal reduction with postoperative manipulation (when necessary) was identified to be 94.5 percent. Using this protocol, surgeons may see a decrease in secondary deformities following closed nasal reduction procedures. Therapeutic, IV.