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Depressed Skull Fracture

Fractured Skull Depressed


Presentation

  • The first case involved a 22-year-old patient who presented with depressed skull fracture overlying the posterior third of the SSS. Symptoms of BIH developed within 48 h.[ncbi.nlm.nih.gov]
  • Abstract Two cases of intrauterine depressed fracture are presented.[ncbi.nlm.nih.gov]
  • However, if clinical and radiological findings of sinus obliteration and related intracranial hypertension are present, surgical decompression is indicated.[ncbi.nlm.nih.gov]
  • Monoparesis is often among its clinical presentations, but midline depressed skull fracture presenting as motor weakness of both lower limbs (Paraperesis) has not yet been reported.[ncbi.nlm.nih.gov]
  • Abstract We describe a full term male infant born by cesarean section, who presented a deep round depression of the left parietal bone at birth.[ncbi.nlm.nih.gov]
Dog Bite
  • The necessity of searching for skull fractures in children following dog bites in this region is emphasized.[ncbi.nlm.nih.gov]
Altered Mental Status
  • All had significant head trauma with altered mental status and a Glasgow Coma Score of 3-12.[ncbi.nlm.nih.gov]
  • All had significant head trauma with altered mental status and a Glasgow Coma Score of 3–12.[karger.com]
  • mental status, or concern for NAT Consult Neurosurgery and hopitalize. [ Addioui, 2016 ] Sometimes, unfortunately, the skull fracture is not due to Gravity, but rather something more sinister.[pedemmorsels.com]
  • Therefore, basic guidelines as to when to seek medical care can include the following: Altered mental status. The child is not acting or behaving normally for that child.[emedicinehealth.com]

Workup

Periostal Elevation
  • Elevation of the depression was therefore made through a small incision along the rear edge of the frontal bone using a periosteal elevator.[ncbi.nlm.nih.gov]
Epileptiform Activity
  • None of the patients developed neurological deficits, cosmetic deformity or electroencephalographic signs of epileptiform activity.[ncbi.nlm.nih.gov]
Clostridium Perfringens
  • Abstract Two cases of Clostridium perfringens infection occurring less than 24 hours after compound depressed skull fracture are reported.[ncbi.nlm.nih.gov]

Treatment

  • Abstract The use of surgical treatment for depressed skull fractures that are located over major venous sinuses is a matter of controversy.[ncbi.nlm.nih.gov]
  • Treatment differed in all 3 cases. One baby underwent surgical elevation of the fracture, and another vacuum elevation, while the third received no treatment.[ncbi.nlm.nih.gov]
  • Abstract Intracranial hypertension caused by a compound depressed skull fracture on the posterior part of the superior sagittal sinus is a rare condition, and nonspecific symptoms and signs can delay appropriate diagnosis and treatment.[ncbi.nlm.nih.gov]
  • Surgical treatment is indicated in symptomatic patients.[ncbi.nlm.nih.gov]
  • To the authors' knowledge, this report is the first description of ventriculoperitoneal shunt insertion as the primary treatment of this infrequent condition.[ncbi.nlm.nih.gov]

Prognosis

  • There were both cosmetic and neurological concerns and we found no clear consensus on appropriate treatment and prognosis in the literature we had available. 2015 BMJ Publishing Group Ltd.[ncbi.nlm.nih.gov]
  • Treatment and prognosis There are a number of indications for operative management, this include 2-4 : dural breach, increased risk if 5mm depression from inner table depression 5-10 mm significant intracranial hemorrhage frontal sinus involvement significant[radiopaedia.org]
  • […] intracerebral bleeds may be present Differential Diagnosis Sutures are symmetrical and have well-corticated margins Treatment Depressed skull fractures usually require elevation of the depressed fragment when it is depressed deeper than the adjacent inner table Prognosis[learningradiology.com]
  • The type of basilar fracture will help decide the patient’s prognosis and treatment plan. Depressed Skull Fractures When a high-energy blunt force strikes a small surface of the skull, it can result in a depressed skull fracture.[kitaylaw.com]

Epidemiology

  • Epidemiology of head injury. J Neurol Neurosurg Psychiatry 1996 ; 60 : 362 –9. Ommaya AK , Genarrelli TA. Cerebral concussion and traumatic unconsciousness: correlation of experimental and clinical observations on blunt head injuries.[emj.bmj.com]
  • Epidemiology of head injury. J Neurol Neurosurg Psychiatry. 1996; 60:362?9. This article on PubMed Golfinos, JG, Cooper, PR. Skull fracture and post-traumatic cerebrospinal fluid fistula. In: Head Injury - 4th edition.[panafrican-med-journal.com]
  • Fractures in Children: Epidemiology and Activity – Specific Fracture Rates. J Bone Joint Surg Am, 2013 Apr 03;95(7). CONTINUE SCROLLING FOR RELATED SLIDESHOW[medicinenet.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology of iatrogenic and traumatic skull base injury. Adv Otorhinolaryngol. 2013;74:12-23. doi: 10.1159/000342264. Epub 2012 Dec 18. Review. PubMed PMID: 23257548.[lifeinthefastlane.com]
  • Serious cases usually result in death Pathophysiology [ edit ] A basilar skull fracture as seen on CT Diagram showing bones that may be involved in a basilar skull fracture Basilar skull fractures include breaks in the posterior skull base or anterior[en.wikipedia.org]

Prevention

  • This clinical and experimental examination should aid in preventing head injuries in skiing accidents because head injuries are mostly the result of depressed fractures, accompanied by brain contusions or hematomas.[ncbi.nlm.nih.gov]
  • Prevention and management measures are briefly discussed.[ncbi.nlm.nih.gov]
  • The extent of the problem and efforts toward prevention are described.[ncbi.nlm.nih.gov]
  • Primary bone fragments should be replaced whenever possible as it prevents the need for cranioplasty and there is no relative risk of increased infection rate.[ncbi.nlm.nih.gov]
  • Clinical Bottom Line The results of the present study do not provide a definitive answer regarding the role of antibiotics in preventing meningitis. There is very little evidence in value of giving antibiotic in depressed compound skull fracture.[bestbets.org]

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