bones of the skull - clinical

Question 1

what do the majority of skull fractures result from?

Answer 1

blunt force / penetrating trauma

Question 2

what are the obvious clinical features of skull fractures?

Answer 2

visible injuries and bleeding

Question 3

what are the subtle signs of fracture?

Answer 3

clear fluid draining from ears + nose (cerebrospinal fluid leak of base of skull fracture)
poor balance
confusion
slurred speech
stiff neck

Question 4

what are the areas of the skull that are natural points of weakness?

Answer 4

pterion
anterior cranial fossa
middle cranial fossa
posterior cranial fossa

Question 5

what is the pterion?

Answer 5

an ‘H-shaped’ junction between temporal, parietal, frontal and sphenoid bones
thinnest part of the skull

Question 6

what can a fracture at the pterion lead to?

Answer 6

lacerate an underlying artery (anterior branch of middle meningeal artery), resulting in a extradural haematoma

Question 7

where is the anterior cranial fossa?

Answer 7

depression of the skull formed by frontal, ethmoid and sphenoid bones

Question 8

where is the middle cranial fossa?

Answer 8

depression formed by sphenoid, temporal and parietal bones

Question 9

where is the posterior cranial fossa?

Answer 9

depression formed by squamous and mastoid temporal bone, plus occipital bone

Question 10

what are the 4 major types of cranial fractures?

Answer 10

depressed
linear
basal skull
diastatic

Question 11

what is a depressed fracture?

Answer 11

a fracture of the bone with depression of the bone inwards

Question 12

when does a depressed fracture occur?

Answer 12

as a result of direct blow

causing skull indentation, with possible underlying brain injury

Question 13

what is a linear fracture?

Answer 13

simple break in bone, traversing its full thickness
have radiating (stellate) fracture lines away from the point of impact

Question 14

which is the most common type of cranial fracture?

Answer 14

linear

Question 15

what is a basal skull fracture?

Answer 15

affects base of skull

Question 16

What does a basal skull fracture present with?

Answer 16

characteristically present with bruising behind ears (Battle’s sign) - mastoid ecchymosis
OR
bruising around eyes/orbits (Raccoon eye’s)

Question 17

what is a diastatic fracture?

Answer 17

fracture occurs along a suture line

causing a widening of the suture

Question 18

which age group is diastatic fracture most commonly seen in?

Answer 18

children

Question 19

are facial fractures common? related to which type of injury?

Answer 19

yes

trauma related - road traffic collisions, fights and falls

Question 20

what are the clinical features of facial fractures?

Answer 20

profuse bleeding, swelling, deformity and anaesthesia of the skin

Question 21

which bone is most frequently fractured in facial fractures? why?

Answer 21

nasal bones

due to their prominent position at the bridge of the nose

Question 22

what is a maxillofacial fracture?

Answer 22

a fracture that affects the maxillae bones

Question 23

how does a maxillofacial fracture occur?

Answer 23

trauma with a large amount of force

Question 24

how can facial fractures affecting the maxillary bones be identified?

Answer 24

using the Le Fort classification, depending on the bones involved, ranging from 1-3
3 = most serious