SKULL FRACTURES

Topic: Skull Fractures. The types of skull fractures, their etiologies,signs and symptoms, clinical presentation, radiologic diagnosis and treatment. We'll also discuss the complications of skull fractures.

1. SKULL FRACTURES Dr.Muhammad Zaid

2. Skull Fracture The skull is a tough, resilient, group of bones which provide protection for the brain. A skull fracture occurs when one of the bones of the skull breaks. It is usually caused by a heavy blow to the head from a car accident, fall or assault. It may be accompanied by injury to the brain.

3. Types of skull fractures 1) Linear Fracture This is the most common type of skull fracture and single fracture line goes through entire skull thickness; no displacement. They usually don’t cause any problems but sometimes they can cause damage to blood vessels underneath and result in a blood clot on the surface of the brain.
If the fracture extends to the base of the skull or sinuses it can result in problems on base of skull fractures. Etiology: Low-energy blunt trauma over wide surface area of skull. When individual falls while awake → occipital impact Fall that follows loss of consciousness → frontal impact Clinically – just tender bump on head; skin may or may not be breached,most patients are asymptomatic, without loss of consciousness.

4. X-rays of linear skull Fracture

5. 2) Compound Fracture Multiple linear fractures that radiate from impact site (≥ 2 bone fragments) This break in the skull involves a tear in the skin and splintering of the bone . Suggests more severe blow (than in single linear fracture). Portion of bone may be depressed.

6. 3) DEPRESSED FRACTURE This fracture involves fragments of bone being pushed downwards and can press below plane of skull. Etiology: Usually small blunt objects (such as hammer or baseball bat). This can cause damage to the underlying brain tissue. These types of fractures can sometimes result in focal seizures (from contusion underlying fracture). Clinically: depression under generalized swelling, focal seizures.

7. 4) BASE OF SKULL FRACTURE ( BASILAR FRACTURE ) This fracture occurs at the bottom of the skull and can involve the bones around the sinuses and ears. Etiology – impact to Occiput or sides of head . Basilar bones are thick – much more force required to fracture them. Often associated with dural tears. Clinically: Ecchymoses (periorbital / retroauricular) distant from point of impact, Cranial nerve palsies, CSF leaks, Pneumocephalus.

8. SIGNS AND SYMPTOMS OF SKULL FRACTURES

9. Diagnosis Fractures can be seen on a plain X-ray of the skull. Sometimes a CT scan may be required also especially if there is a question of an underlying brain injury.

10. Treatment Treatment of fractures depends on the type of fracture. Not all fractures require an operation and will heal over time especially most linear fractures.
A depressed fracture that is pressing deeply into the brain is usually repaired and requires surgery to elevate the bony pieces and to inspect the brain for evidence of injury. The bone is lifted back and secured in position. Leaks of brain fluid often resolve spontaneously after 7- 10 days. However sometimes surgery may be required to find the leak and repair it if possible. If the wound is open and dirty and the bone fragments are loose then an operation may be performed to clean and repair the wound. The fractured bone may be removed if it is too damaged or infected and may be left out for a while until infection settles down.

11. Complications Increased Risk of intracranial bleeding and infection. Bleeding: Subdural hematoma, Epidural hematoma CSF Leaks: Otorrhea and rhinorrhea after basilar fractures Meningitis: may extend into brain abscess Post-traumatic epilepsy: after depressed fractures,risk factors: loss of consciousness for > 2 hours, associated dural tear, early seizures (within first week). Cranial nerve palsies