Injuries to the nose are common in contact sports such as soccer, football and basketball. Nasal injuries can include bleeding, nasal fractures or septal hematomas.  A broken nose is an actual break in the cartilage or bone of the nose caused by a direct blow. It is one of the most common fractures of the face, usually caused by the separation of the frontal portion of the facial bones or as the separation of the cartilage within the nose itself. Sometimes the injury can involve both.

Signs and Symptoms:

• Excessive bleeding

• Extreme pain

• Swelling 

• Deformity

• Inability to breathe through nose

• Crepitus (crackling or popping sound)

On-Site Management:

ABC's. Make sure the blood is not impeding the athlete's airway, and that the athlete is breathing properly. Check for a pulse and monitor the heart rate for shock. With any injury to the face it is important to first assess the athlete to rule out a head injury, as this is potentially more serious and must be managed first.

Once a head injury has been dealt with, the main objective initially is to stop the bleeding.  Sit the athlete upright and apply direct pressure on the lower portion of the nose for up to 20 minutes.  Placing ice across the bridge of the nose can help constrict the blood vessels and stop the bleeding. If the bleeding has subsided in 20 minutes and there is no visible deformity the athlete may pack the nose with absorptive gauze.  If the bleeding has not subsided within 20 minutes or there is a visible deformity, refer the athlete to a physician as they may have a nasal fracture or septal hematoma.  

Medical Referral:

The athlete should see a doctor as soon as possible after the injury. If needed, the physician will reduce the fracture either immediately or at a more convenient time depending on the nature of the fracture and any complications that the individual athlete may have.  It may be necessary to re-break the nose to achieve proper alignment.  If the athlete has a septal hematoma it may need to be excised, drained and then packed.  This should only be done by a professional. 

Return to Activity:

The athlete should not return to activity until he or she is given clearance by the physician. Athletes involved in contact sports should wear a nose protector upon return.

Prevention:

• Make sure athletes wear the appropriate protective face masks and shields for their sports.

Brukner, P. and Khan, K. Brukner and Khan's Clinical Sports Medicine Brukner, P. and Khan, K. (2007) Brukner and Khan's Clinical Sports Medicine. 4th ed. North Ryde: McGraw-Hill.