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PubMed1984

Incidence of skull fractures in Olmsted County, Minnesota.

Between 1935 and 1974, 3598 episodes of head trauma among Olmsted County, Minnesota, residents resulted in 1097 skull fractures. Of these, 53% were simple, 16% were depressed, 12% were compound, and 19% were basilar. The age-and sex-adjusted incidence of skull fractures was 44.3 per 100,000 person-years overall, was somewhat greater in the urban than in the rural areas of Olmsted County, and was relatively stable for the final 30 years of the study. Age-specific incidence rates were highest for the very young, and simple linear fractures were the predominant type of skull fracture in this age group and among the elderly. The male:female ratio of incidence rates varied from 2.1:1 to 4.5:1 depending on fracture type. Motor vehicle accidents accounted for 38% of the skull fractures and were a particularly important cause among young males. Falls accounted for 37% of the skull fractures and were the major cause of fractures in the elderly and pediatric age groups. The results of this population-based study may be helpful in formulating recommendations for the evaluation and management of head-injured patients.

Adolescent↗
PubMed1989

Short-term outcomes of skull fracture: a population-based study of survival and neurologic complications.

All Olmsted County, Minnesota, residents who experienced brain injury from 1935 through 1979 were identified and their medical records reviewed for survival and neurologic outcome. Minimum inclusion criteria included loss of consciousness or post-traumatic amnesia or neurologic evidence of brain injury or skull fracture. Of 4,660 cases identified, skull fractures were observed in 28%. Over half of brain-injured patients who died did so within 24 hours of trauma; among 1-day survivors, subsequent survival was moderately impaired, especially in older individuals. Mortality was lowest in subjects without a skull fracture and increased with fracture severity. Associated neurologic injuries, complications, and deficits were generally more common in patients with skull fracture than those without and were much more frequent with more severe skull fractures. The types of neurologic deficits differed little between those with and without fractures, except that subjects with complicated skull fractures had higher proportions of special sensory deficits and multiple deficits.

Adult↗
PubMed1999

Revival of non-surgical management of neonatal depressed skull fractures.

The management of depressed skull fractures in the newborn infant can be controversial. We report on a neonate, born by Caesarean section with difficult head extraction, complicated by a parietal depressed fracture. This 'ping-pong' fracture was treated by elevation with an obstetrical vacuum extractor. No complications occurred. The possible treatment modalities for neonatal depressed fractures, being conservative or operative, will be discussed.

Adult↗
PubMed2005

Growing skull fracture: a posttraumatic neosuture.

CONTEXT: A case of a growing skull fracture presenting in adulthood is reported. Pertinent literature was reviewed with an emphasis on pathogenesis. EVIDENCE ACQUISITION: A search through MEDLINE from 1994 through 2004 was used and supplemented by searches of secondary sources retrieved from referenced articles. EVIDENCE SYNTHESIS: Current hypotheses for the pathogenesis of growing skull fractures were critically analyzed. A new hypothesis based in more recent data is proposed in an attempt to better understand this process. CONCLUSIONS: The proposed hypothesis seems to explain better the timing in which the clinical features in growing skull fracture develop.

Adult↗
PubMed1987

Radiographic characteristics of skull fractures resulting from child abuse.

Radiographic characteristics of skull fractures in 39 cases of documented child abuse were compared with skull fractures in 95 cases of accidental injury to determine if differential features could be identified. All children were less than 2 years old. Emergency room and hospital records for these patients were also reviewed. The results of this study show that clinical features did not provide any clues as to whether the children had been injured by abuse or by accident. However, it was found that multiple fractures, bilateral fractures, and fractures crossing sutures occurred significantly more often in abuse cases than in accidental injury. When such fractures are present, abuse should be suspected.

Accidents↗
PubMed1977

Growing skull fractures.

Four cases of growing skull fracture in children are presented and the reasons for poor surgical results are analyzed. The clinical presentation, causative factors, and operative findings are discussed.

Female↗
PubMed1990

The significance of skull fracture in acute traumatic intracranial hematomas in adolescents: a prospective study.

A prospective study was conducted to validate the retrospective finding that adolescents (11 to 15 years old) with skull fractures were prone to develop acute traumatic intracranial hematoma (ICH). Over a 4-year period, 1178 consecutive adolescents attended the emergency room directly, of whom 760 were discharged well and 418 were admitted. All underwent skull x-ray studies. Immediate computerized tomography (CT) scans were performed in patients with Glasgow Coma Scale (GCS) scores of less than 15, in those with radiological and/or clinical evidence of skull fracture, and whenever clinically indicated. Of the 418 admitted patients, only 26 had skull fractures; 13 of these developed ICH. Four patients without skull fracture developed diffuse brain swelling. The remaining 401 patients were discharged after observation periods of up to 48 hours. Of the 13 patients with ICH, 10 had admission GCS scores of 15; however, four deteriorated rapidly and required urgent operation, and four remained stable but were operated on due to their large ICH. Two required conservative treatment only and both made good recovery. Three patients were in coma (GCS score less than or equal to 8) on admission. One patient had an epidural hematoma and made good recovery after surgery. Two developed delayed ICH after operations for associated systemic injuries despite initial CT showing diffuse brain swelling only, and both died despite evacuation of the ICH. Multivariate analysis showed that skull fracture was the only independent significant risk factor in predicting ICH in adolescents (sensitivity of 100% and specificity of 97%). A routine skull x-ray study is therefore mandatory in all head-injured adolescents and, if a skull fracture is detected, immediate CT may be performed for early detection of ICH.

Acute Disease↗
PubMed1981

Delayed carotid-cavernous fistula and multiple cranial neuropathy following basal skull fracture.

A case of basilar skull fracture associated with palsies of the 3rd through 10th cranial nerves on the ipsilateral side is presented. Three months after the initial injury, despite return of significant ocular movement, proptosis and conjunctival congestion heralded the onset of an ipsilateral carotid-cavernous fistula. Angiography revealed the presence of a carotid-cavernous fistula; however, the ipsilateral carotid artery was occluded in the neck. A single pathophysiological mechanism is proposed to account for this unique series of events.

Adult↗
PubMed1988

[Growing skull fracture with rapid growth: a case report].

A case of growing skull fracture with rapid growth is presented. A 4-month-old male fell and struck the right side of his head. Skull X-ray just after injury showed a right parietotemporal linear skull fracture with the maximum width of 4 mm. The width of the fracture line increased to 9 mm 7 hours after injury. Serial CT scan demonstrated growth of contusional hematoma just beneath of the fracture. Six days later, a pulsatile mass was palpated beneath the scalp, although neurological state was normal. The width of the fracture line was demonstrated to increase up to 11 mm on X-ray at that time. CT scan revealed subgaleal cerebral herniation surrounded by brain edema. He was operated 11 days after injury. It is thought that the contusional hematoma and following brain edema played an important role in the genesis of rapid growth of the skull fracture.

Encephalocele↗
PubMed1996

Skull fractures in children: a population study.

OBJECTIVE: To provide information about children with a skull fracture in the Edinburgh area, since head injury is the single most important traumatic cause of death in children over 1 year of age. METHODS: During the period January 1983 to December 1989, all children in the Edinburgh area under 13 years of age who sustained a skull fracture were identified. Details of the children who died primarily from a head injury, and the total number of children who were admitted to hospital with a head injury not associated with a skull fracture, were also documented. Data were obtained from the General Register Office for Scotland, Edinburgh Fiscal Office records, and Lothian Health Board records. Data on cause of injury and clinical condition were obtained. RESULTS: 3498 children under 13 years of age were admitted to hospital after sustaining a head injury and 27 died primarily as a result of their injuries; 409 children had a skull fracture and 76 of this group had cranial CT scans. Nineteen of the CT scans performed were on children who had been admitted to hospital in a coma, and all had abnormal scan findings. In addition all children with intracerebral haematomas/haemorrhages had been admitted in a coma. Road traffic accidents accounted for the greatest number of deaths (84%), associated injuries, and overall morbidity. CONCLUSIONS: To reduce the incidence of head injuries, and the associated morbidity and mortality, the following are required: identify at risk groups; promote accident prevention; publicise the findings and guidelines concerning childhood head injuries; ensure that all children with head injuries have appropriate investigations and begin treatment as early as possible; establish clinical audit; and set up regional rehabilitation teams.

Accidents, Traffic↗
PubMed1977

[Iatrogenic evolutive skull fracture (author's transl)].

A case of growing skull fracture secondary to a maxilofacial operation is reported. Frequency, clinical symptoms, phisiopathology and treatment of growing skull fractures are reviewed and the rarity of the iatrogenic mechanism is stressed.

Child↗
PubMed1999

Growing skull fracture of the orbital roof. Case report.

Growing skull fractures are rare complications of head trauma and very rarely arise in the skull base. The clinical and radiological finding and treatment of a growing fracture of the orbital roof in a 5-year-old boy are reported, and the relevant literature is reviewed. The clinical picture was eyelid swelling. Computed tomography (CT) scan was excellent for demonstrating the bony defect in the orbital roof. Frontobasal brain injury seems to play an important role in the pathogenesis of the fracture growth. Growing skull fracture of the orbital roof should be considered in the differential diagnosis in cases of persistent ocular symptoms. Craniotomy with excision of gliotic brain and granulation tissue, dural repair and cranioplasty is the treatment of choice.

Brain Diseases↗
PubMed2005

[The application of the dissociate bone flap in treatment of the macrosis depressed skull fracture on the frontal orbit part].

OBJECTIVE: To study the reconstructive effect of the dissociate bone flap to repair the macrosis depressed skull fracture on the frontal and orbit part. METHODS: The coronal scalp flap was elevated and dissociate bone flap was expanding to the 2cm width beside the edge of depressed skull fracture. The first step was to extract the dissociate bone flap and make there is an area for operating . Then extract free bone fragments, and elevate the depressed orbital lamina and use the biological glue to stick it to its position. The free fragments extracted were stacked into a whole one and it to its position in use of the biological glue on the dissociate bone flap. The uneven inner table should was smoother with bon-wax. The prosthetic dissociate bone flap was put back on its position and fixation. RESULTS: From January 2000 to December 2004, 17 cases of the macrosis depressed skull fracture on the frontal and orbit part undertaken plastic surgery by the dissociate bone flap to treat the macrosis depressed skull fracture and obtained excellent curative effect. CONCLUSIONS: Using dissociate bone flap to treat the mocrosis depressed skull fracture on the frontal and orbit part can avoid the complication of the traditional operation, and make the method become a plastic surgical operation.

Adult↗
PubMed1980

Pseudogrowth in skull fractures of childhood.

We report two cases in which linear fractures of the parietal bone in infants healed spontaneously after initial enlargement suggested growth of the fracture line. We suggest the term "pseudogrowing skull fracture" to indicate this phenomenon. Growing skull fractures are best managed by early surgical correction. It is, therefore, important to recognize that some fractures may heal after an initial period of growth.

Female↗
PubMed1998

Growing skull fracture after cranial vault reshaping in infancy.

Growing skull fractures are reported in three infants undergoing cranial vault surgery for craniosynostosis. Although primary dural injury was overt in only one patient, an extensive dural defect with spatially coincident bony absence was identified in all patients at late exploration. The coincidence of dural injury, deficient overlying bone, and a pulsatile growing brain are necessary conditions for the development of growing skull fractures. With the advent of increasingly radical cranial vault procedures during infancy, the potential for this complication to arise may increase. Definitive correction requires autogenous tissue reconstruction of the dural and bony defect.

Child, Preschool↗
PubMed1977

Growing skull fracture of childhood with reference to the importance of the brain injury and its pathogenetic consideration.

It is recognized that the presence of a dural tear is essential in the development of a growing skull fracture. We present nine cases of growing skull fracture, stressing the importance of parenchymal injury beneath the skull and dural defects as pathogenic factors, and two cases which showed pathological conditions similar to those of growing skull fracture. According to our clinicla analysis, all of these cases followed head trauma in the first year of life. The area of cranial defect varied in size among the individual cases but was progressive in all instances. Convulsions were the most frequent symptom. With both radiologicla examinations and operative findings, it is recognized that dural tears and local cerebral injury are usually severe, and various localized ventricular enlargements are always found beneath the fracture. In many cases fibrous granulation was found filling in the bone defect and adhering to the contused cortex. The mechanism of the enlarged bone defect can be explained by classifying the lesions into three groups according to the type of tissue present: (1) granulation type; (2) cyst type, and (3) mixed type. Each type prevents the bone edge from spreading out, offering a suitable means to transmit mechanical pulsations of brain and cerebrospinla fluid. The formation of granulation tissue and dense scarring is an important factor in the growing skull fracture.

Brain Diseases↗
PubMed1978

Basilar skull fractures in children. The incidence of CNS infection and the use of antibiotics.

Forty-six cases of basilar skull fractures in children were reviewed to determine the incidence of CNS infection following injury and the possible value of antimicrobial chemoprophylaxis. The clinical course of the children who were treated with antibiotics was compared with that of patients who received no antimicrobial therapy. Included in the study were patients with hemotympanum alone or with hemotympanum plus additional clinical or roentgenographic signs of basilar skull fracture; patients with tympanic membrane perforation without otorrhea but with blood in the auditory canal; and children with either otorrhea or rhinorrhea. Acute, delayed, or recurrent infection of the CNS did not develop in any of the patients. This study is the first of its kind presented in children. It would seem on the basis of the present series that the systematic use of antibiotic prophylaxis in children with hemotympanum following basilar skull fractures is unwarranted and that children with other signs of basilar skull fractures may have an equally small risk of meningitis following injury.

Adolescent↗
PubMed2006

Depressed skull fractures in children: Treatment using an obstetrical vacuum extractor.

INTRODUCTION: A depressed skull fracture is an inward buckling of the skull bones. It is referred to as a ping-pong ball fracture in neonates; in older children, some fractures take a cup shape mimicking 'ping-pong' ball fractures. OBJECTIVE AND METHODS: The aim of this study was to assess the use of an obstetric vacuum extractor to elevate cup-shaped depressed skull fractures in children irrespective of age. All children admitted into the Central Hospital of Yaounde between 1999 and 2004 with a cup-shaped simple depressed skull fracture and treated with the vacuum extractor were included. RESULTS: Nine children aged from 3 months to 17 years were treated with the vacuum extractor. The cosmetic and radiographic results were satisfactory. The procedure was simple and without any complication. CONCLUSION: The elevation of 'ping-pong-ball-like' or 'cup-shaped' skull fractures in older children (beyond the neonatal period) is a simple, effective and safe procedure.

Adolescent↗