December case 2 (Full Version)

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Dr.Wagner -> December case 2 (December 13, 2007 2:13:33 PM)

30 year old male MMA fighter received a knee to the face during a "thai clinch".  This resulted in a knock out.

What is the diagnosis.




[image]local://2287/2CFE85D884B741E8841C98CE5ADAED67.jpg[/image]



Dr.Wagner -> RE: December case 2 (December 13, 2007 2:14:21 PM)

pic 2


[image]local://2287/0B456D2A12694E9196DB20B4A86B1C0F.jpg[/image]



bonez -> RE: December case 2 (December 13, 2007 2:34:39 PM)

Well on first glance there is nasal angulation externally and bleeding so first thought would be a nasal fracture. The view into the nares shows crowding in the right side so besides the fracture is the septum evulsed as well?



steve -> RE: December case 2 (December 14, 2007 3:00:47 AM)

No idea about the nose but thought a pic of a great Muai Thai clinch might be helpful.[image]http://img164.imageshack.us/img164/816/richfranklinnose2iu7.jpg[/image]

Makes your nose look like this:

[image]http://img507.imageshack.us/img507/540/richfranklinnosedd3.jpg[/image]



Sebastian Asselbergs -> RE: December case 2 (December 14, 2007 7:42:43 AM)

I'm with bonez here - my nose looked like that twice in my life. I would love to say it was during a big fight......(once because my face hit a wall, once because I fell on it on a branch)



ehanso -> RE: December case 2 (December 14, 2007 9:53:24 AM)

Rx: Dr 90210 :)



jma -> RE: December case 2 (December 14, 2007 12:05:52 PM)

fractured nasal bone with detached nasal septum?



Dr.Wagner -> RE: December case 2 (December 14, 2007 12:37:53 PM)

Steve you are the man...just wanted to say that.  Thank you for posting that...but I like this one...(I'm a Pride FC guy)



[image]local://2287/EB253883B2C54799A9A58D0A346ED6EB.jpg[/image]



steve -> RE: December case 2 (December 14, 2007 7:21:23 PM)

Hey Wags,

I like Pride too but they have basically been bought up by UFC and all the guys are transitioning over to the UFC. Silva/Liddel should be an interesting bout to watch....



Dr.Wagner -> RE: December case 2 (December 15, 2007 1:09:27 AM)

The case is that of a nasal fracture with co-existing Nasal Septum HEMATOMA.  This is identified by the 'grape like' hematoma.  It requires immediate surgical attention to avoid septal necrosis...



Steve...yeah, UFC bought pride, but the new organization M1 may bring back some Pride glory.



gerry -> RE: December case 2 (December 17, 2007 10:37:41 AM)

Wags,

I would like your opinion.  My son had his nose broken during broom hockey.  (Teenagers-on ice-in a mall-in Alabama-wearing tennis shoes-swinging large sticks.  Go figure)  It was about 10:00, so we went to the ER.  X-rays were taken and the ER doc said it was not broken.  I asked why it was off to the side (it looked about like Steves picture), and he said he wasn't sure.  To be fair, the swelling did make it appear straighter than it was when I first saw it. 

We went to the ENT the next day who did a CT scan and showed us the multiple breaks.  It was then reset under anesthesia.

My question.  When is an ER visit needed for a broken nose?  The ENT said if breathing was OK, and the bleeding was stopped, it was OK to wait to the next day to be seen.  What would you recommend?  Thanks!



Dr.Wagner -> RE: December case 2 (December 17, 2007 6:06:11 PM)

you dont really need to go to the er for an isolated closed nasal fracture...unless you see the septal hematoma.  



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