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Basilar fracture symptoms8/7/2023 A dressing held in place by a circumferential head bandage is often NOT sufficient. Initial management consists of steady direct pressure at the source of bleeding. Open or closed skull fractures can be associated with large scalp lacerations with profuse bleeding that can be difficult to control. Therefore, maintaining immobilization of the cervical and thoracic spine is of great importance. High kinetic energy is needed to cause a skull fracture. Prehospital personnel should assume a skull fracture exists in any patient who has sustained a significant head injury or other major trauma. PREHOSPITAL MANAGEMENT - The priorities of prehospital trauma management remain unchanged in patients with skull fractures. The smaller the area receiving the blow and the greater the energy delivered, the more likely that a depressed fracture will result. The amount and dispersion of the kinetic energy involved primarily determine whether a skull fracture is linear or depressed. Skull fractures occur from direct trauma to the head. Other high risk fractures include those over the transverse or sagittal sinus, due to the increased risk of major bleeding, and basilar skull fractures resulting in cerebral spinal fluid (CSF) otorrhea or rhinorrhea. The thin cribriform plate is often shattered. (See "Intracranial epidural hematoma in adults" and "Subdural hematoma in adults: Etiology, clinical features, and diagnosis".)įractures involving the frontal sinus are also considered high risk they are frequently associated with contusions to the anterior portion of the frontal lobes and with dural tears. This is due to the temporal bone's relative weakness and the proximity of the middle meningeal artery and vein. Patients who sustain a fracture of the temporal bone are at high risk for extra-axial hematoma (ie, bleeding beneath the skull but outside the brain parenchyma). In adults, the bones of the skull average between 2 and 6 mm in thickness the bones in the temporal region are usually the thinnest and therefore at the greatest risk of fracture. Each bone consists of solid inner and outer layers, separated by a layer of cancellous bone (the diploë). ![]() The unique layered architecture of these bones enhances the skull's strength. ĪNATOMY AND MECHANISM OF INJURY - The skull is made up of the frontal, ethmoid, sphenoid, and occipital bones, two parietal bones, and two temporal bones ( figure 1 and figure 2 and figure 3). The most common causes of head injury in adults include:Īlthough skull fractures themselves may or may not indicate the presence of significant TBI, certain skull fracture types, such as depressed skull fractures, basilar skull fractures with associated cerebral spinal fluid (CSF) leak, and fractures of the temporal-parietal bone that traverse the middle meningeal artery and vein, are associated with significant morbidity and mortality. According to another retrospective study of 2254 cases of head trauma from assault, approximately one-third sustained a skull fracture. Īccording to one retrospective study of 207 head-injured patients, 37 percent of those with associated intracranial pathology sustained a linear skull fracture. Each year, approximately 2.8 million people sustain head injuries in the United States alone, resulting in approximately 2.5 million emergency evaluations, 300,000 hospital admissions, and 60,000 deaths. Much of the data on skull fractures in adults come from studies of traumatic brain injury (TBI). ![]() (See 'Definition and presentation of skull fracture types' below.) ![]() Linear fractures are the most common, followed by depressed and basilar skull fractures. The parietal bone is most frequently fractured, followed by the temporal, occipital, and frontal bones. (See "Skull fractures in children: Clinical manifestations, diagnosis, and management" and "Intracranial epidural hematoma in adults" and "Subdural hematoma in adults: Etiology, clinical features, and diagnosis" and "Nonaneurysmal subarachnoid hemorrhage" and "Acute mild traumatic brain injury (concussion) in adults".)ĮPIDEMIOLOGY - The incidence of skull fractures among head injured adults who present to emergency departments (ED) is unknown. Skull fractures in children and intracranial injuries are discussed separately. The epidemiology, mechanisms, clinical presentation, associated complications, and initial management of skull fractures in adults are reviewed here. Significant skull fractures are often accompanied by moderate or severe intracranial injury and extracranial injuries associated with high-energy trauma, such as cervical and other spine fractures and thoracoabdominal injuries. ![]() They occur when forces striking the head exceed the mechanical integrity of the calvarium. INTRODUCTION - Skull fractures have plagued humankind throughout history.
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