Skull fractures (summary)
This is a basic article for medical students and other non-radiologists
Skull fractures usually occur following significant head injury and may herald underlying neurological pathology.
Reference article
This is a summary article; read more in our article on skull fractures.
Summary
- anatomy
- epidemiology
- accurate incidence and prevalence unknown
- 1.3 million traumatic brain injuries per year in the USA
- estimated that 1/3 will have a skull fracture
- presentation
- head injury following impact trauma, e.g. fall, RTC
- symptoms associated with underlying injury
- there may be an associated base of skull injury
- CSF rhinorrhea
- Battle sign (bruising over mastoid process)
- raccoon eyes
- pathophysiology
- mechanism
- children and elderly: simple fall
- adults: usually high-energy impact trauma, e.g. RTC
- different types of fractures
- linear
- depressed skull fracture
- diastatic (widening suture lines in childhood)
- base of skull fracture
- growing skull fracture
- ping pong fracture
- associations
- bone fragments under the fracture
- other penetrating injuries
- intracranial hemorrhage
- mechanism
- treatment
- head injury patients should be treated following ATLS (or similar)
- C-spine control and ABCDE
- assessment of Glasgow coma scale (GCS)
- treatment depends on the type of fracture
- linear: no specific treatment
- depressed: may require neurosurgical intervention to prevent further brain injury
- base of skull fracture: may be unstable and require expert
- head injury patients should be treated following ATLS (or similar)
Imaging
- role of imaging
- diagnosis of fracture
- skull x-rays are still performed but are being used less and less
- CT head is the first line investigation
- assessment for intracranial injury, e.g. hemorrhage
- assessment of the need for imaging using a clinical scoring system
- NICE guidance
- Canadian CT head rule
- assessment of the need for imaging using a clinical scoring system
- assessment of fracture to guide risk stratification and management
- diagnosis of fracture
- radiographic features
- CT
- best method for looking for bony injury
- best test for looking at extra-axial collection or brain injury
- allows assessment for other signs, e.g. pneumocephalus
- review on different windows (brain, blood, bone)
- 3D reconstruction
- CT