Skull fractures (summary)
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This is a basic article for medical students and other non-radiologists
Skull fractures usually occur following significant head injury and may herald underlying neurological pathology.
Reference article
This is a summary article; read more in our article on skull fractures.
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
-
treatment
- head injury patients should be treated following ATLS (or similar)
- C-spine control and ABCDE
- assessment of Glasgow 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)
Imaging
-
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
- 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
-<h6>This is a basic article for medical students and other non-radiologists</h6><p><strong>Skull fractures</strong> usually occur following significant head injury and may herald underlying neurological pathology.</p><h4>Reference article</h4><p>This is a <a href="/articles/summary-article">summary article</a>; read more in our article on <a title="Skull fractures" href="/articles/skull-fractures">skull fractures</a>.</p><h4>Summary</h4><ul>- +<h6>This is a basic article for medical students and other non-radiologists</h6><p><strong>Skull fractures</strong> usually occur following significant head injury and may herald underlying neurological pathology.</p><h4>Reference article</h4><p>This is a <a href="/articles/summary-article">summary article</a>; read more in our article on <a href="/articles/skull-fractures">skull fractures</a>.</p><h4>Summary</h4><ul>
-<li>skull x-rays are still performed but are being used less and less</li>- +<li>
- +<a title="Skull radiography" href="/articles/skull-radiography">skull x-rays</a> are still performed but are being used less and less</li>
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