The Barn Doors Greenstick Fracture-A New 3D Geometry for Common Osteotomies in Rhinoplasty: The First 50 Patients with 1-Year Follow-up

Ferreira MG, Santos M.

What this paper says

In 50 consecutive primary rhinoplasty patients, a three part incomplete bone fracture pattern gave significant improvement in appearance and breathing scores at one year, with a visible step on the bridge in 4 percent.

Overview

A greenstick fracture bends bone without breaking it through, so the segments stay connected. The barn doors concept combines three adjacent greenstick fractures: one across the nasal bones in the center of the bridge and one on each side wall of the bony pyramid. The authors ran a prospective study on 50 consecutive patients undergoing primary rhinoplasty by spare roof technique B.

Sections of note

Design: prospective, interventional, longitudinal study of 50 consecutive patients.
Outcome tool: the validated Portuguese Utrecht questionnaire, completed online before surgery and at 3 and 12 months. Breathing was scored with a visual analog scale for each side.
Patients were also asked whether they felt a step on the bridge, whether it was visible, and whether it bothered them.
Utrecht questionnaire scores improved significantly after surgery.
Mean breathing scores improved significantly on both the right and left sides.
At 12 months, 10 percent felt a step on the bridge, and it was visible in 4 percent, two women with thin skin.

What it means for a patient

A step or ridge on the bridge is the classic problem after bone cuts, and here it was visible in 2 of 50 patients at one year, both with thin skin.
Both appearance and breathing scores improved and were measured with a validated questionnaire rather than surgeon opinion.
Limits: 50 patients, one technique, one practice, no comparison group receiving conventional osteotomy.
Thin skin appears to be the risk factor for a visible irregularity, since thin skin hides less.

Why this paper matters

Where and how the nasal bones are cut determines whether the transition from bridge to side wall stays smooth. Keeping the bones connected as a greenstick, especially at the root of the nose, aims to prevent the step patients notice years later. Whether this geometry outperforms standard osteotomy would need a controlled comparison.

Terms

Greenstick fracture: a bend that cracks one side of the bone without separating it.
Osteotomy: a planned cut or controlled fracture of bone.
Bony pyramid: the triangular bony upper third of the nose.
Spare roof technique: a preservation method that folds rather than removes the cartilage roof.
Utrecht questionnaire: a validated patient questionnaire for aesthetic rhinoplasty outcomes.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“The "barn doors greenstick fracture" is a new concept that includes three contiguous greenstick fractures: one in the central compartment of the nasal dorsum (nasal bones) and two on the lateral walls of the bony nasal pyramid. The present study aimed to describe this new concept and to report the first esthetical and…”

Excerpt; the full abstract is on PubMed.