Skull fractures (summary)

Dr Derek Smith et al.

Skull fractures usually occur following significant head injury and may herald underlying neurological pathology.

Reference article

This is a summary article; we do not have a more in-depth reference article.

  • epidemiology
    • accurate incidence and prevalence unknown
    • 1.3 traumatic brain injuries per year 1
      • estimated that 1/3 will have a skull fracture
  • presentation
  • pathophysiology
    • mechanism
      • children and elderly: simple fall
      • adults: usually high-energy impact trauma, e.g. RTC
    • different types of fractures
    • associations
      • bone fragments under the fracture
      • other penetrating injuries
      • intracranial haemorrhage
  • investigation
    • non-contrast CT head is the first line investigation
    • assessment of the need for imaging using a clinical scoring system
      • NICE guidance
      • Canadian CT head rule
  • treatment
    • head injury patients should be treated following ATLS (or similar)
      • C-spine control and ABCDE
      • assessment of GCS
    • treatment depends on the type of fracture
      • linear: no specific treatment
      • depressed: may require neurosurgical intervention to prevent further brain injury
      • base of skull fracture: may be unstable and require expert care; they carry a high risk of morbidity 2
  • assessment for intracranial injury, e.g. haemorrhage
  • diagnosis of fracture
  • assessment of fracture to guide risk stratification and management
CT

This is the best method for looking for bony injury and any underlying extra-axial haemorrhage or parenchymal insult.

Examining with the bone and soft tissue windows is important, with other signs including pneumocephalus or bleeding into paranasal sinuses.

With volume CT, 3D reconstruction allows accurate depiction of skull fractures.

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Article Information

rID: 34340
Synonyms or Alternate Spellings:
  • Basal skull fracture (summary)

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Cases and Figures

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    Case 5: fracture with bone fragments
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    Case 2: linear skull fracture (3D CT)
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    Case 3: ping-pong fracture (3D CT)
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    Case 1: skull fracture
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    Case 4: small linear fracture (CT)
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