Depressed skull fractures result in the bone of the skull vault being folded (depressed) inward into the cerebral parenchyma. It is usually the result of a high energy impact to the skull.
These mostly (~75%) occur in the frontoparietal region 3.
There are number of associated injuries with depressed skull fractures 1,2:
- extradural haematoma
- subdural haematoma
- cerebral contusion
- subarachnoid haemorrhage
- CSF leak
Rarely undertaken, especially outside of the paediatric population. The fracture is identified due to the projection of dense bone over the skull.
The modality of choice in head trauma. The fracture is shown in detail along with any associated injuries.
Treatment and prognosis
There are a number of indications for operative management, this include 2-4:
- dural breach, increased risk if > 5mm depression from inner table
- depression >5-10 mm
- significant intracranial haemorrhage
- frontal sinus involvement
- significant wound comtamination or cosmetic deformity
Depressed skull fracture are associated with higher rates of infection (~10%), seizure (~15%), neurological deficits, and death 3.
- 1. Brant WE, Helms CA. Fundamentals of Diagnostic Radiology. Lippincott Williams & Wilkins. (2007) ISBN:0781761352. Read it at Google Books - Find it at Amazon
- 2. Pope TL. Harris & Harris' Radiology of Emergency Medicine. Lippincott Williams & Wilkins. (2012) ISBN:145110720X. Read it at Google Books - Find it at Amazon
- 3. The Neurosurgeon's Handbook. Oxford University Press. ISBN:0198570678. Read it at Google Books - Find it at Amazon
- 4. Kaye. Essential Neurosurgery. John Wiley & Sons. (2009) ISBN:1405148179. Read it at Google Books - Find it at Amazon