Skull fractures (summary)
Updates to Article Attributes
Body
was changed:
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.
Summary
- anatomy
-
epidemiology
- accurate incidence and prevalence unknown
- 1.3 million traumatic brain injuries per year in the USA 1
- estimated that 1/3 will have a skull fracture
-
presentation
- head injury following impact trauma, e.g. fall, RTC
- symptoms associated with underlying injury
- there may be an associated base of skull injury
- CSF rhinorrhoea
- Battle sign (bruising over mastoid process)
- raccoon eyes
-
pathophysiology
- mechanism
- children and elderly: simple fall
- adults: usually high-energy impact trauma, e.g. RTC
- different types of fractures
- linear
- depressed skull fracture
- diastatic (widening suture lines in childhood)
- base of skull fracture
- growing skull fracture
- ping pong fracture
- associations
- bone fragments under the fracture
- other penetrating injuries
- intracranial haemorrhage
- mechanism
-
role of imaging
- diagnosis of fracture
- skull x-rays are still performed
,but are being used less and less - CT head is the first line investigation
- skull x-rays are still performed
- assessment for intracranial injury, e.g. haemorrhage
- assessment of the need for imaging using a clinical scoring system
- NICE guidance
- Canadian CT head rule
- assessment of the need for imaging using a clinical scoring system
- assessment of fracture to guide risk stratification and management
- diagnosis of fracture
-
radiographic features
- CT
- best method for looking for bony injury
- best test for looking at extra-axial collection or brain injury
- allows assessment for other signs, e.g. pneumocephalus
- review on different windows (brain, blood, bone)
- 3D reconstruction
- CT
-
treatment
- head injury patients should be treated following ATLS (or similar)
- C-spine control and ABCDE
- assessment of
GCSGlasgow coma scale (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
- head injury patients should be treated following ATLS (or similar)
-<li>CSF rhinorrhoea</li>- +<li><a title="CSF rhinorrhoea" href="/articles/csf-rhinorrhoea">CSF rhinorrhoea</a></li>
-<li>intracranial haemorrhage</li>- +<li><a title="Intracranial haemorrhage" href="/articles/intracranial-haemorrhage">intracranial haemorrhage</a></li>
-<li>skull x-rays are still performed, but are being used less and less</li>- +<li>skull x-rays are still performed but are being used less and less</li>
-<li>Canadian CT head rule</li>- +<li><a title="Canadian CT head rule" href="/articles/canadian-ct-head-rule">Canadian CT head rule</a></li>
-<li>best test for looking at extra-axial collection or brain injury</li>-<li>allows assessment for other signs, e.g. pneumocephalus</li>- +<li>best test for looking at <a title="Extra-axial collection (summary)" href="/articles/extra-axial-collection-summary">extra-axial collection</a> or <a title="Traumatic brain injury" href="/articles/traumatic-brain-injury">brain injury</a>
- +</li>
- +<li>allows assessment for other signs, e.g. <a title="Pneumocephalus" href="/articles/pneumocephalus">pneumocephalus</a>
- +</li>
-<li>assessment of GCS</li>- +<li>assessment of <a title="Glasgow coma scale (GCS)" href="/articles/glasgow-coma-scale">Glasgow coma scale (GCS)</a>
- +</li>
Unable to process the form. Check for errors and try again.