Correlation Between CT Manifestations and Treatment Strategy in Nasal Bone Fractures

To determine the association between detailed CT manifestations of nasal bone fracture and treatment strategy, emphasizing whether CT-derived structural severity can stratify conservative treatment, closed reduction, and open reduction/septorhinoplasty.

This retrospective imaging-based analysis included 80 patients with nasal bone fractures treated between January 2023 and May 2026. Thin-section CT indicators included maximum displacement, bony overlap, fracture laterality, fracture-line count, comminution, depressed segment, septal fracture, septal deviation angle, lateral nasal wall fracture, maxillary frontal process fracture, adjacent midface fracture, sinus opacification, soft-tissue swelling, and a composite CT severity score. The primary outcome was treatment strategy. Multivariable logistic regression was used to evaluate active reduction, and receiver operating characteristic analysis was used to assess the CT score.

Conservative treatment was used in 19 patients, closed reduction in 41, and open reduction/septorhinoplasty in 20. Median CT severity score increased stepwise across these groups: 2, 5, and 9, respectively. Each 1-point increase in CT severity score was independently associated with active reduction [adjusted odds ratio, 1.50; 95% CI, (1.01, 2.24); P=0.047]. The CT score showed good discrimination for active reduction, with an area under the curve of 0.82.

CT features reflecting bony instability, septal involvement, and adjacent midface extension were strongly aligned with treatment selection. A structured CT severity score may help standardize nasal fracture triage and clarify when to favor closed or open reduction.