Tripod suspension and stabilisation: an innovative splintage technique for closed reduction of comminuted and compound fractures of the nasal bones

Background Comminuted and compound fractures of the nose pose a surgical dilemma for the treating surgeon. There is a general belief that in such cases, a secondary septorhinoplasty is often required after a closed reduction and so there is a bias towards adopting an open or modified open reduction technique in the first instance. We, however, believe that a change in the splinting strategy after a closed reduction can make use of the innate advantages of the nasal structure and avoid a lot of major surgeries and consequent discomfort and expenses. Methods Thirty-six patients with comminuted/compound fractures of the nose were enlisted in the study after due informed consent. After standard closed reduction, a new splintage technique developed by us, the ‘Tripod suspension and stabilisation technique’ was employed and kept for up to 3 weeks. The patients were then interviewed a minimum 8 weeks post splint removal to assess their levels of satisfaction regarding aesthetics and function of the nose post reduction on a visual analog scale. Results Thirty-six patients having comminuted or compound fracture nasal bone were splinted by this technique after closed reduction and followed up for subjective assessment at least 2 months later. While 95 % were quite satisfied with the aesthetic outcome and 97 % with the nasal function, only one felt the need for (and subsequently underwent) a septorhinoplasty. Conclusions Tripod suspension and stabilisation is an effective and rational technique for splintage following closed reduction of comminuted/compound fractures of nasal bones. It is convenient for patients as they can breathe through their noses and do not restrict any activity while the splints are on. It is very stable and versatile and reduces hospitalisation as no packs are required and has shown excellent long-term functional and aesthetic results thereby reducing the need for open procedures. Level of Evidence: Level IV, therapeutic study.