7. Classification of skull fractures, and treatment principles

Question 1

How are scull fractures classified?

Answer 1

Linear fracture
Depressed fracture
Diastatic fracture (in children at sutures)
Basilar fracture

Question 2

What is a diastatic fracture?

Answer 2

fracturealong one or more of the suture lines of the skull causing a widening of the suture.

Question 3

What is the treatment for a linear skull fracture?

Answer 3

No treatment is necessary if non-contrast CT reveals no underlying brain injury or depressed fracture

if theres suspicion or clinical evidence of brain injury : admit for observation

Question 4

What is the treatment for a depressed skull fracture?

Answer 4

Operative, elevation of dislocated bone fragments, fixation (suture, wire)
prophylactic measure is recommended : AB (5-7 day vancomycin +cefipime), tetanus prophylaxis, anticonvulsant (phenytoin, carbamazepine)

Question 5

What is the treatment for a diastatic skull fracture?

Answer 5

Conservative???

Question 6

What is the treatment for a basilar skull fracture?

Answer 6

-Conservative : elevate head 60 degrees

if persistent leak: surgery to stop leak

Question 7

What are the symptoms of basilar skull fracture?

Answer 7

bruising around the eyes
CSF leak from the nose or ear occurs in about 20% of cases

involves atleast 1 of the 5 bones of the base of the skull
occurs most commonly through temporal bone; high risk of extra-axial bleeding (esp epidural hematoma)

Question 8

What are the complications of basilar skull fracture?

Answer 8

MENINGITIS is 15% of cases

Question 9

what other injuries occur with significant skulll fractures?

Answer 9

• intracranial injury
• extracranial injuries (ass. with high energy trauma)
  *cervical fracture
  *spine fractures
  *thoracoabdominal injuries

Question 10

clinical finding that suggest skull fracture or intracranial injury?

Answer 10

• AMS
• focal crania nerve or focal neurologic deficit
• scalp laceration or contusion
• bony step off skull
• periorbital or retroauricular ecchymosis
• headache
• N/V

Question 11

Dx of skull fractures

Answer 11

• Non-cotrast CT (including bone window)
• MRI (vascular or ligament injury)
• If CT unavailable : 2 view XRAY (AP and lateral view)

Question 12

which fracture is hard to see on XRAY

Answer 12

depressed skull fracture
basilar skull fracture

Question 13

how do depressed fractures occur

Answer 13

small area receiving the blow; hence greater energy is delivered
which is more likely to result in depressed fracture

Question 14

if patient is on anticoagulant and got a skull fracture, what are they at high risk for

Answer 14

intracerebral hemorrhage
should be admitted for observation regardless of absence of hemmorhage on initial CT imaging