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At least 19 recordsLinked to original sources
PubMed1989

Can computed tomography be relied upon to detect skull fractures?

Skull fractures were detected on plain films in 63 of 100 consecutive head-injured patients admitted to a neurosurgical unit. On routine computed tomographic (CT) lateral scout films, only 58% of lateral fractures were detected and there was a false positive rate of 12%. None of the anterior or posterior fractures was seen. On the routine axial CT cuts only 22.5% of fractures were detected. When examined at bone window settings, 76% of vertical and 37.5% of oblique linear fractures were detected but none of the horizontal fractures. All comminuted and depressed fractures were demonstrated when the axial cuts were examined at bone window settings and in all but one case by the scanogram and at routine brain window settings. Basal fracture extent was better shown by axial CT than on plain films, especially at bone window settings. Recommendations are made regarding the use of CT in the detection of skull fractures.

Humans↗
PubMed1976

[An infantile skull fracture followed by the enlarging of the fracture line ("enlarging skull fracture") (author's transl)].

We experience sometimes an infantile skull fracture which is followed by the skull fracture line and bulging of the fractured area day by day after the head injury. Since John Howship reported the case of the partial absorption of the right parietal bone, arising from a blow on the head in a child aged 9 month in 1816, this phenomenon was variously described meningocele spuria, traumatic cephalohydrocele, leptomeningeal cyst, fibrosing osteitis, cerebrocranial erosion, traumatic meningocele, die wachsende Schädelfrakture, growing skull fracture, etc. So called "growing skull fracture" has generally the triad of the symptoms which are the parietal skull fracture in infancy or childhood, traumatic dural tears, and subsequent enlargement of the fractures. And it is said that the dural tear is an indispensable condition for the developing of the "growing skull fracture". But we recently had the case of a 14 day old male infant who had neither traumatic dural tear nor subdural hematoma, but the progressive enlarging of the fracture line in the left parietal bone. The authors suggest that there should be the difference between the growing skull fracture (with the dural teat) and the enlarging skull fracture (without the dural tear).

Fractures, Ununited↗
PubMed1994

Recurrent pneumococcal meningitis. Search for occult skull fracture.

Skull fractures, particularly those affecting the base of the brain and extending to the sinuses and petrous pyramids, are the most common cause of recurrent bacterial meningitis. Detection of sinus fracture can be difficult in children. Thin-section computed tomographic scanning aids the diagnosis in patients with a remote history of head injury. Other causes of recurrent bacterial meningitis include congenital cranial and spinal cord defects, foci of infection, and immune system disorders. Streptococcus pneumoniae is often the infectious organism. Treatment includes surgical repair of any anatomic defects and use of appropriate antibiotic therapy.

Adolescent↗
PubMed1993

Comparative evaluation of digital radiography versus conventional radiography of fractured skulls.

OBJECTIVES: The authors assessed the relative efficacy of conventional and digital storage-phosphor radiographs for the detection of skull fractures. METHODS: Fifty conventional film-screen radiographs (FSR) and 50 digital storage-phosphor radiographs (DR) with 66 fractures were compared. Five radiologists evaluated image quality and fracture detectability. The results were analyzed by receiver operating characteristic (ROC) curve analysis. RESULTS: With a standard exposure, the ability to evaluate skull fractures was equally good with either technique (ROC area for DR, 0.8954; for FSR, 0.8870). Digital radiography was superior in evaluating nasal bone. For petrosal bone, the DR image simulates an underexposure. This disadvantage compared with FSR can be compensated by image postprocessing. CONCLUSION: In evaluation of skull fractures, radiologists performance with DR is equivalent to FSR.

Adolescent↗
PubMed1992

How much monitoring is needed for basilar skull fractures?

Basilar skull fractures account for approximately 19% of all skull fractures. There have been little data published concerning the need for intensive care monitoring in this injury. We retrospectively studied 259 patients admitted to our trauma center over an 8-year period with a diagnosis of basilar skull fracture. All patients were evaluated with cranial computed tomographic (CT) scans. These patients were admitted to the trauma service, and neurosurgical consultation was obtained in all cases. The diagnosis was made by clinical signs in 207 patients (80%), by CT scan in 47 (18%), and by plain films in 5 (2%). Ninety-two patients (group I) had intracranial pathology in addition to basilar skull fracture. Twenty-one patients in this group underwent craniotomy. In this group, the morbidity and mortality rates were 11% and 7%, respectively. Forty-four patients (group II) had no intracranial pathology and a Glasgow Coma Score (GCS) of less than 13. The morbidity was 2%, and the mortality was 2%. One hundred twenty-three patients (group III) had no intracranial pathology on CT scan and a GCS of 13 or greater. The complication rate in this group was 1%, and there was no neurologically related mortality. Patients who are admitted with a diagnosis of basilar skull fracture and who have a GCS of 13 or greater with no intracranial pathology on CT can be managed without intensive care monitoring.

Adolescent↗
PubMed1999

Adult growing skull fracture mimicking a skull tumor.

Growing skull fractures (GSF) are rare in adults. We report the case of an adult who was found to have a GSF 50 years after head trauma. This case highlights the need to consider GSFs in the differential diagnosis of adults with intradiploic skull lesions.

Craniocerebral Trauma↗
PubMed1990

CT evidence of intracranial contusion and haematoma in relation to the presence, site and type of skull fracture.

The skull films and CT scans of 1383 patients with acute head injury transferred to a regional neurosurgical unit were reviewed. Of the 850 patients with a skull fracture, contusion and/or haematoma was found in 71%, compared with 46% of the 533 patients with no fracture. Thirty-nine per cent of patients had neither contusion nor haematoma, and 21% had neither skull fracture nor contusion/haematoma. Haematomas occurred more frequently in association with lateral and occipital fracture than with frontal fracture, but the incidence of contusion was similar for all fracture sites. Linear fractures were more often associated with extra- and subdural haematomas than were depressed fractures. Intracranial damage associated with depressed fractures was localized more frequently than with linear fractures. Frontal fractures were rarely associated with posterior damage alone, but with occipital fractures anterior contusion was more frequent than posterior. Damage associated with lateral fracture was solely contralateral in 26%. Skull fracture was present in 77% of patients with contusion, 87% of those with an extradural, 72% with a subdural, and 66% with an intracerebral haematoma (70% of all those with an intracranial haematoma).

Brain Concussion↗
PubMed1995

Mechanisms of basilar skull fracture.

Basilar skull fractures comprise a broad category of injuries that have been attributed to a variety of causal mechanisms. The objective of this work is to develop an understanding of the biomechanical mechanisms that result in basilar skull fractures, specifically focusing on mandibular impact and neck loading as potential mechanisms. In the characterization of the injury mechanisms, three experimental studies have been performed. The first study evaluated the response of the base of the skull to midsymphysis loading on the mental protuberance (chin) of the mandible. Five dynamic impacts using a vertical drop track and one quasi-static test in a servohydraulic test frame have been performed. In each test, clinically relevant mandibular fractures were produced but no basilar skull fractures were observed. The second study assessed the fracture tolerance of the base of the skull subject to direct loading on the temporomandibular joint in conjunction with tensile loading imposed locally around the foramen magnum to simulate the effect of the ligaments and musculature of the neck. Among four specimens that sustained either complete or incomplete basilar skull ring fractures remote from the sites of load application, the mean load at fracture was 4300 +/- 350 N. Energy to fracture was computed in three of those tests and averaged 13.0 +/- 1.7 J. Injuries produced were consistent with clinical observations that have attributed basilar skull ring fractures to mandibular impacts. In the third series of experimental tests, loading responses resulting from cranial vault impacts were investigated using unembalmed human cadaver heads and ligamentous cervical spines. Multiaxis load cells and accelerometers, coupled with high-speed digital video, were used to quantify impact dynamics. The results of these experiments suggest that while there is a greater probability of cervical spine injury, basilar skull ring fractures can result when the head is constrained on the impact surface and the inertia of the torso drives the vertebral column onto the occiput.

Biomechanical Phenomena↗
PubMed1999

Growing skull fractures.

Growing skull fractures are rare complications of severe closed head injury occurring almost exclusively in infants and children under the age of three. The reported incidence is between 0.05% and 0.6%. Two such cases were treated at our institution. Both cases presented with bulging mass and underlying skull defect two months after head injury. They received surgical treatment and achieved excellent results. Early diagnosis and surgical intervention are essential for these patients to prevent progressive brain damage. Therefore, close follow-up for patients at risk of developing growing skull fracture is necessary.

Craniocerebral Trauma↗
PubMed1993

Digital radiography versus conventional radiography for the detection of a skull fracture under varying exposure parameters.

RATIONALE AND OBJECTIVES: The effect of varying exposure parameters on the detectability of a fracture with digital and conventional radiography were examined. METHODS: A macerated fractured skull was imaged by film-screen radiography (FSR) and digital storage phosphor radiography (DR) with various exposure values. Five radiologists traced the course of a fracture line. The length of the fracture was reported and the results were analyzed by Student's t test for paired samples. RESULTS: At 35% of the conventional radiation dose, the standard DR screen displayed an average of 48% of the fracture length. The difference from the conventional image (45%) was not significant in this case. An increase of the dose to ten times the conventional dose (250 mAs) yielded no significant improvement in the detectability of the length of the fracture (51%). CONCLUSIONS: This experiment shows that with use of the DR with the standard screen, a dose reduction of approximately 35% appears to be possible without any resulting loss of image quality compared to FSR. Use of the high resolution screens should be avoided, since they require a higher incident image dose than standard screens without offering any diagnostic advantages. The image dose of digital radiographs can be roughly estimated based on the digital device sensitivity value. As a rule, the sensitivity value should range between 100 and 200.

In Vitro Techniques↗
PubMed1990

Intrauterine growing skull fracture.

Growing skull fractures with development of leptomeningeal cysts are rare complications of head injuries and have not been described in the perinatal period. The case history of a newborn with bilateral parietal fractures and the formation of a leptomeningeal cyst on one side detected at birth is presented. The importance of radiographic evaluation, including skull films, computered tomography, and magnetic resonance imaging, as well as the associated subarachnoid cyst and the age of presentation are discussed.

Arachnoid Cysts↗
PubMed2003

Growing skull fractures.

Growing skull fractures or craniocerebral erosions are rare sequel to cranial fractures where progressively growing cranial defects follow lacerations involving the duramater. Their usual site is the parietal region. They present as a cystic, non-tender swelling with an underlying palpable bony defect. One such case is reported.

Child Development↗
PubMed1996

The value of MRI in the early diagnosis of growing skull fracture.

Growing skull fracture (GSF) is a progressive enlargement of a fracture due to an underlying tear of the dura mater. It is a rare complication of severe head injury mainly reported in young children. Classically, the diagnosis is made during follow-up, late after the original injury, when a palpable skull defect or a bulging mass is discovered clinically. Initial skull radiographs show a diastatic fracture developing later into a large bony defect. CT will show the brain damage which is usually present beneath the fracture. We present the MRI findings of GSF in a series of eight children. All patients initially had a large linear fracture and underlying brain damage on CT. In all cases MRI showed a zone of the same intensity as the brain contusion or cerebrospinal fluid advancing through the bone margins of the fracture to the subcutaneous plane. This finding was interpreted as an indirect sign of the dural tear. Seven patients were operated on with surgical confirmation of GSF. MRI can make an early diagnosis of GSF possible so that surgical repair with closure of the dura can be carried out before the dural tear enlarges.

Brain↗
PubMed1995

Pathogenesis and treatment of growing skull fractures.

BACKGROUND: Growing skull fractures are poorly understood complications of pediatric skull fractures. METHODS: A retrospective review of skull fractures at our institution from 1980-1993 revealed 10 patients with growing skull fractures. The age at injury ranged from 1-144 months, with 9 of 10 patients being under one year of age. The etiology of these fractures included falls, motor vehicle accidents, and child abuse. On average, growth of the fracture was diagnosed 14 months after the initial injury. RESULTS: Six patients have had magnetic resonance imaging (MRI) with one demonstrating leptomeningeal cyst herniation, two having brain herniation, and three having both brain parenchyma and leptomeningeal cyst herniation. All patients had malacic cortex underlying the fracture, but there was no evidence of intracranial hypertension. Nine patients have undergone craniotomy with excision of granulation tissue and gliotic brain, dural repair, and cranioplasty using surrounding normal skull. There were no surgical complications or recurrences. CONCLUSIONS: Brain/leptomeningeal cyst herniation through a dural rent, without MRI evidence of increased intracranial pressure, implicates physiologic growth and brain cerebrospinal fluid (CSF) pulsations as the cause of fracture enlargement.

Child↗
PubMed2001

[Spontaneous resolution of a congenital depressed skull fracture].

Congenital depressed skull fracture is rare and in most cases its etiology remains unclear. We present a female newborn infant with a congenital depressed skull fracture and no evidence of antepartum or intrapartum traumatism. The baby had normal neurological status and the depressed fracture healed spontaneously in a few weeks. Based on our experience of this case and a literature review, we conclude that congenital depressed skull fractures should be managed conservatively if the skull depression is less than 2cm, there is no previous trauma, no local edema or hematoma, and if the neonate shows normal neurological status.

Female↗
PubMed1994

Depressed skull fractures in children secondary to skull clamp fixation devices.

The use of external skull fixation devices (skull clamps) is a common practice in neurosurgery. The insertion of pins into the skull is usually routine and uneventful in adult patients. However, the safety of skull clamp fixation devices in children is not reported. We have examined our complications over the past 6 years, and have encountered 5 children with depressed skull fractures secondary to application of a skull clamp fixation device. There were 3 boys and 2 girls with ages ranging from 3 to 8 years (mean 5.8 years). Two patients had brainstem gliomas, 2 patients had hypothalamic gliomas and 1 patient had a medulloblastoma. Four of the children required separate cranial procedures for exploration and elevation of the depressed fractures. There were no sequelae associated with the depressed fractures. We conclude that skull clamp fixation devices are safe, but should be used with caution in the pediatric patient. In addition, we present several modifications of existing skull clamps which may decrease the risk of depressed skull fractures.

Brain↗