Approximately 25% of all skull fractures are compound and merit immediate attention. Inadvertently fracture segments are removed in emergency to worsen the cosmetic problem. To analyze the benefit of primary reconstruction of depressed fracture and compare the various options available today. Thirty two patients underwent primary fracture reconstruction, from a study period of Feb2005 to Nov 2007 were analyzed retrospectively. The various techniques adopted by the author like simple elevation, apposition by nylon suture; or rigid fixation by titanium and absorbable mini plate were undertaken. Twenty two patients were male and ten were female. Eighteen (56%) cases underwent titanium miniplate fixation and eleven (34%) apposition using nylon sutures. In two cases simple elevation of fracture segments was carried out and in one fixation with absorbable (Poly-L- lactide) miniplate, was performed. Infection and Plate rejection were not encountered in this study. Cosmetic deformity correction to acceptable level was achieved better with miniplate. Primary reconstruction of fracture segment should be attempted as and when possible. Even in India, titanium mini plate is cost effective and better option to any other available measures.

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Occurrence of pneumocephalus following a head trauma is relatively rare. Tension pneumocephalus can manifest as severe headache, dizziness, mental changes, and even seizure; therefore, urgent diagnosis and treatment are mandatory. The Mount Fuji sign on CT scans of the brain is useful in discriminating tension pneumocephalus from nontension pneumocephalus. Deterioration due to an increase in subdural air volume can be evacuated by craniotomy. Though uncommon, tension pneumocephalus is a life-threatening complication that requires urgent diagnosis and treatment.

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