bubble_chart Overview

The skull is a spherical-like bony shell that contains and protects the cranial cavity. The significance of a skull fracture lies not in the fracture itself but in the complications it may cause to the contents of the cranial cavity. Fractures are classified by shape into linear fractures, depressed fractures, comminuted fractures, and growing fractures in children. Fragments from depressed or comminuted fractures can injure the meninges and brain, as well as cerebral blood vessels and cranial nerves. Skull fractures account for approximately 15–20% of traumatic brain injuries and can occur in any part of the skull, most commonly in the parietal bone, followed by the frontal bone, then the temporal and occipital bones. Typically, fracture lines do not cross cranial sutures, but excessive force may extend the fracture to adjacent bones. Anteroposterior and lateral skull X-rays can confirm the diagnosis. Treatment and prognosis vary depending on the type of fracture.

bubble_chart Clinical Manifestations

1. Linear fracture: The head injury area may or may not have scalp contusion. If not combined with intracranial injury, there are usually no significant symptoms. If combined with intracranial hematoma, brain or cranial nerve injury, corresponding symptoms and signs will appear. 2. Depressed fracture: Local deformation, depression, scalp swelling, and subcutaneous hematoma occur in the skull. It may cause local contusion and laceration. Larger fractures can lead to brain compression. Sometimes the venous sinus is injured, combined with intracranial hematoma, and epilepsy may occur in the early or advanced stages after the injury. 3. Comminuted fracture: The injury is more severe, often combined with scalp contusion and cerebral contusion. 4. Growing fracture: Mostly seen in infants under 3 years old. There is a previous linear fracture, and 3–4 months later, the scalp at the fracture site becomes raised with pulsation and fluctuation. Puncture can extract cerebrospinal fluid with high protein content. Over time, the skull fracture line widens and may even form a skull defect.

bubble_chart Diagnosis

1. History of head trauma. 2. Linear fracture: Skull X-ray shows single or multiple fracture lines. 3. Depressed fracture: Skull X-ray shows overlapping bone fragments, increased density, displaced bone fragments, or localized depression. In infants, skull depression often appears as a ping-pong ball-like indentation. 4. Comminuted fracture: Skull X-ray shows multiple intersecting fracture lines. 5. Growing fracture: After injury, swelling in the affected area does not subside, or 3-4 months later, the scalp at the fracture site becomes raised with pulsation and fluctuation. Repeat skull X-ray shows widening of the linear fracture.

bubble_chart Treatment Measures

1. For any skull {|###|}fracture{|###|}, observe for the presence of combined intracranial hematoma, brain {|###|}contusion{|###|}, and cranial nerve {|###|}injury{|###|}, and treat them simultaneously. 2. Linear {|###|}fracture{|###|}, minor depressed {|###|}fracture{|###|}, and comminuted {|###|}fracture{|###|} without displaced fragments can heal on their own. 3. Surgical intervention is required in the following cases: (1) {|###|}Fracture{|###|} complicated by intracranial hematoma. (2) Depressed {|###|}fracture{|###|} located in the motor area, or depression depth exceeding 1 cm, with a large depressed area causing brain compression. (3) {|###|}Fracture{|###|} fragments piercing the dura mater, leading to brain {|###|}contusion{|###|} or hemorrhage. (4) {|###|}Fracture{|###|} fragments injuring major venous sinuses. (5) Open skull {|###|}fracture{|###|} or non-healing wounds with retained bone fragments. (6) Growing {|###|}fracture{|###|}.

The skull is a rigid spherical bony cavity that houses and protects brain tissue. Adults can withstand a static weight of 280 kg and energy of 400–900 pounds. Exceeding these limits may cause {|###|}fracture{|###|}, and the secondary {|###|}injury{|###|} caused by the {|###|}fracture{|###|} is far more severe than the {|###|}fracture{|###|} itself. When a skull {|###|}fracture{|###|} is detected via X-ray, vigilance for intracranial hematoma is necessary, and changes in the patient's condition should be closely monitored within 48 hours. If the condition worsens, an early cranial CT scan should be performed to promptly identify intracranial hematoma. If {|###|}fracture{|###|} fragments penetrate the brain or compress functional areas, leading to seizures, early surgery is required. Linear {|###|}fractures{|###|} in infants and young children often heal within 3–4 months. If healing is not expected, pediatric growing {|###|}fracture{|###|} should be considered and treated.

bubble_chart Cure Criteria

1. Cure: The scalp wound has healed after merging, surgical reduction or fracture fragment removal, symptoms have disappeared, with no significant sequelae. 2. Improvement: Postoperative symptoms have improved, with no significant neurological complications. 3. Unhealed: The fracture has not been reduced or the fracture fragment has not been removed, and symptoms have worsened.