Skull fractures

Types

  • Linear skull fractures
    • Typically from low-energy blunt trauma over a wide surface area of the skull.
    • Runs through entire thickness of bone, but usually does not cause any major complications unless it runs through a vascular space.
    • may cause an epidural haematoma and venous sinus thrombosis.
    • Vault fracture is the technical name for a fracture of the ‘external’ skull.
  • Basilar skull fractures
    • Basilar fractures are actually a subtype of linear fractures affecting the skull base.
    • Commonly there is damage to the anterior fossa
      • Features include classical ‘raccoon eyes’ or periorbital ecchymosis)
      • Subconjunctival haemorrhage is common
      • CSF rhinorrhea and anosmia is not uncommon
        • may require surgery for repair of the dura
    • temporal bone damage
      • causing ‘battle’s sign’ or mastoid ecchymosis)
      • Longitudinal temporal bone fractures (affecting the middle fossa) may also cause some deafness if there is build up of oedema in the ear.
      • Also CSF otorrhoea
  • Depression Fracture
    • Commonly due to high-energy direct blow to small surface area of the skull with a blunt object (e.g. bat), causing a depression of the skull contours.
    • The result is often an intracranial bleed and oedema at the fracture site.
  • Open/Compound fractures
    • Fracture whereby there is communication between the internal environment and the external environment
    • High risk of infection
    • Debridement and dural closure is important

Investigation and Management

  • Imaging
    • CT imaging for bleeding/other damage
    • Occipito-mental view X-ray for basal fractures
  • Management is often conservative.  Surgery is indicated where there is high risk of complications e.g. infection, bleeding, etc

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