The skull is made of 22 separate bones, responsible for encasing and protecting the brain and cerebrospinal fluid. When blunt force trauma causes a skull fracture, the delicate brain and fluids are at risk of damage. Depending on the type and severity of the skull fracture, victims can suffer mild pain to severe brain damage. An overview of the types of skull fractures possible in an accident can help injured individuals understand their prognoses and treatment plans.
Linear Skull Fractures
When a low-energy blunt trauma affects a wide surface area of the skull, it can cause a linear skull fracture. In these fractures, the trauma runs through the entire thickness of the skull. Most linear skull fractures are relatively insignificant, unless it runs through a suture, venous sinus groove, or vascular channel. In these cases, the fracture could cause venous sinus thrombosis and occlusion or epidural hematoma, or bruising. Simple linear fractures are the most common type of skull fracture.
To qualify as a fracture, a break in the skull must be greater than 3 mm in width, widest at the center and narrow at the tips, run in a straight line (typically), run through the outer and inner lamina of bone, and have angular turns. If the break is less than 2 mm in width, uniform width throughout, and does not run in a straight line, it’s a skull suture, not a fracture.
Basilar Skull Fractures
A basilar skull fracture is, in essence, a linear fracture located at the base of the skull. Basilar fractures exist in certain points on the skull’s base. Dural tears usually accompany this type of fracture. In 75% of all skull base fractures, temporal bone fractures also occur. There are three different types of temporal bone fractures:
- This fracture occurs in the temporoparietal region of the skull.
- Transverse fractures begin at the foramen magnum and end at the middle cranial fossa.
- A mixed fracture has components of both longitudinal and transverse fractures.
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. Hitting someone in the head with a baseball bat is an example of an incident that could result in a depressed skull fracture. Reduction of bone fragments begins at the point of maximum impact and spreads from that point onward. Most depressed skull fractures occur over the frontoparietal region because the skull is thinner here and prone to breaking.
A depressed skull fracture can be open or closed. In an open fracture, there is open skin at the point of breakage – either a skin laceration or the bone breaking through the skin. In an open fracture, the bone is visible through the skin. In a closed fracture, the bone within the skull breaks but is not visible through the skin. In other words, the skin remains intact. Patients who suffer a depressed skull fracture may or may not lose consciousness.
Treatments for Skull Fractures
Patients who do not suffer any neurological damage from a skull fracture such as a linear or basilar fracture can typically return home to heal naturally. If a fracture is open, the patient may require antibiotics to reduce the risk of contamination. Children with open depressed fractures require surgery to elevate the depressed skull fractures. If the underlying brain tissue is swollen or damaged, surgeons may recommend a craniectomy, or removing part of the skull to allow a swollen brain room to expand. Patients with skull fractures may or may not need follow-up appointments during recovery.
Source:
http://emedicine.medscape.com/article/248108-overview#a7