Depressed skull fracture: Prognosis of patients after conservative or surgical management

Abstract

Introduction:The fracture of skull is considered as severe injury and have grave prognosis. It is mainly because of complications of the acute head injury affect the brain directly or indirectly. Compound depressed fractures are surgical emergencies and unless t reated promptly and properly complications like meningitis, cerebral abscess and osteomyelitis of skull may occur. Objectives: to determine the causes of depressed fracture skull and its complications and also to find out various presentation and sever ity of depressed skull fracture and effective modality of management. Materials and Methods: A prospective study undertaken at department of surgery in coordination with emergency department. Detailed inquiry was done about history of demographic data, presenting symptoms and other diseases done. General, central nervous system examination, other systems examination and local examination were done thoroughly and documented. Patients were treated accor ding conservatively and operatively as per decision taken by surgeon. Results: Out of total 100 patients, assault (43%) was most common, followed by vehicular accident (41%), fall of patients (15%) and fall of object on the patients (1%). Patients with severe head injury (GCS<8) were 16 with 7 death after management. Among 94 cases of compound fractures, 34 cases frontal region, 6 had temporal, 9 had fronto-parietal, 25 had parietal, 15 had temporo-parietal and 6 had occipital fracture. Dura tear was seen in 21% of the cases. Among total 100 patients 44 treated operatively and 56 treated conservatively. Conclusion:Conservative management is better in patients with CT scan suggestive of depressed skull fracture nor more than 10 mm and not intracranial hematoma. Patients with depressed skull fracture with more than 10 mm with severe head injury and associate hematoma are better managed operatively.