Skull Fractures Flashcards
how do skull fractures occur?
when forces striking the head exceed the mechanical integrity of the skull
Skull Fractures
which bone is most likely to fracture? next 3 most likely?
- parietal
- temporal, occipital, frontal
Skull Fractures
most common fracture type? next 2 most likely?
- linear
- depressed, basilar
Skull Fractures
most common causes of head injuries
- falls
- assaults
- MVCs
- penetrating missiles
Skull Fractures
bones of the skull
- frontal
- ethmoid
- sphenoid
- occiptal
- 2 parietal
- 2 temporal
Skull Fractures
avg thickness of bones in adults
2-6mm
temporal region is the thinnest
Skull Fractures
immbolize what with any skull fracture associated w/ head injury?
c-spine and t-spine
Skull Fractures
what to do when pt arrives to ER w/ skull fracture
3
- identify & stabilize life threatening injuries
- protect and stabilize airway
- then assess for: altered mental status, focal neurologic deficits, scalp lacerations, bony step off, periorbital or retroauricular ecchymosis
Skull Fractures
what should you not do to scalp wounds?
probe them
Skull Fractures
dx
- non-contrasted CT
- MRI if suspecting vascular or ligament injury
- NO BENEFIT of skull x rays
Skull Fractures
dx if basilar fracture is suspected
- CT angiography to assess for vascular injury
Linear Skull Fractures
describe this fracture type
single fracture that extends through the entire thickness of the skull
Linear Skull Fractures
most often involve which bones?
- temporoparietal
- frontal
- occipital
Linear Skull Fractures
clinical significance
minimal!
Linear Skull Fractures
when is there clinical significance?
- if the linear fracture crosses the middle meningeal groove in the temporal bone or major venous sinuses
Linear Skull Fractures
why is it worrying if the linear fracture crosses the middle meningeal groove or major venous dural sinuses?
- can cause significant extra axial bleeding (beneath the skull but outside the brain parenchyma)
Linear Skull Fractures
common presentation
- if simple + closed: no neurologic sx
- can have swelling over fracture site
Linear Skull Fractures
a minority of these patients develop what?
ICH
Linear Skull Fractures
management
4 components
- no specific intervention necessary if CT reveals no underlying brain injury or depressed fracture
- emergent neuro consult if ICH
- neuro checks
- can observe in ED or admit for monitoring
Depressed Skull Fractures
how to these occur?
- occur when trauma drive a segment of skull below the level of the adjacent skull
Depressed Skull Fractures
often involve injury to the?
brain parenchyma
Depressed Skull Fractures
complications
3
- CNS infection
- seizure
- death
Depressed Skull Fractures
what can you do but must be very careful?
palpate the depression! (often limited due to swelling)
Depressed Skull Fractures
DO NOT do what
blindly probe the wound
Depressed Skull Fractures
management
- Prophylactic meds due to increased risk of infection (tetnus, abx, anti-convulsants)
- admission (enruosurgery or non-operative management)
Depressed Skull Fractures
when to send to OR
- depressed more than the thickness of the skull
Depressed Skull Fractures
when to manage non-operatively
- no evidence of dural penetrations or complication on CT
- if fracture is closed
Basilar Skull Fractures
involve at least one what five bones?
5
- cribiform plate of ethmoid bone
- orbital plate of frontal bone
- petrous and squamous portion of temporal bone
- sphenoid bone
- occipital bone
Basilar Skull Fractures
most commonly occur through what bone?
temporal
Basilar Skull Fractures
suspect what if temporal bone is involved?
epidural hematoma
Basilar Skull Fractures
what artery/vein is the temporal bone located near?
- middle meningeal artery/vein
Basilar Skull Fractures
clinical signs
8
- periorbital ecchymosis (raccoon eyes)
- retroauricular ecchymosis (Battle’s sign)
- otorrhea (CSF leak from ear)
- rhinorrhea (CSF lead from nose)
- hemotypanum (blood behind TM in ear)
- Neurologic presentation (depends on location)
- CN deficits depending on location
- dural tear
Basilar Skull Fractures
rare but significant complication
traumatic carotid cavernous fistula
Basilar Skull Fractures
Management
- surgical emergency if ICH
- admit for observation (EVERYONE)
- close neuro monitoring
- CSF leaks should self resolve
- glucocorticoids for CN palsies
Elevated Skull Fracture
occur when?
the fracture fragment is elevated above the underlying skull
Elevated Skull Fracture
which bone most commonly affected?
frontal
Elevated Skull Fracture
associated with?
significant intracranial injury
Elevated Skull Fracture
usually blank rather than blank
- tangental
- perpendicular
Penetrating Skull Fracture
results of?
- gun shots
- stab wounds
- blast injuries
Penetrating Skull Fracture
complications?
2
- significant brain injury
- significant brain hemorrhage
Anti-Coagulated Pts
what are pts on warfarin or clopidogrel at high risk of?
ICH
Anti-Coagulated Pts
what to do with these pts regardless of skull fracture type?
admit for observation
Anti-Coagulated Pts
what to do at first sign of neurologic deterioration
STAT non-contrasted CT of the head
Anti-Coagulated Pts
what could you consider?
reversal of anti-coag status
