Ping pong skull fracture

Last revised by Yaïr Glick on 19 Jun 2023

Ping pong skull fracture or pond skull fracture refers to a depressed skull fracture of the infant skull caused by inner buckling of the calvarium. It is seen in newborns because of the soft and resilient nature of their bones (like greenstick fractures of long bones) and the fracture line is not visualized radiologically.

A shallow trench is noted on the surface of the skull, and the periosteum and dura are intact. Usually, it is not associated with significant neurological injury. 

It could occur both as birth trauma or due to postnatal blunt trauma. In the former, it usually results from the pressure caused by mother's pelvic bones against the soft skull during labor. Forceps used during delivery could also be a cause. 

May be seen as a smooth inward indentation of the calvarium. A distinct fracture line is not seen.

It can be either treated conservatively or surgically, depending on the severity of depression.

Spontaneous elevation has been described in ping pong fractures that occurred after birth trauma, however, it is extremely rare in infants after head trauma 4.

The fracture is called a 'ping pong' fracture because it resembles a ping pong ball that has been indented inwards with a finger.

Imaging differential considerations include:

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