The Evolution of Modern Treatment for Depressed Skull Fractures

Stein, Sherman C.

doi:10.1016/j.wneu.2018.10.045

Cited by 31 publications

(20 citation statements)

References 68 publications

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“…Complex fractures might be clinically more obvious due to a focal soft-tissue swelling or deformity of skull shape (20). However, linear fractures may not be accompanied by remarkable edema or swelling of the scalp.…”

Section: Discussionmentioning

confidence: 99%

Can three-dimensional reformatted computed tomography scans be useful to avoid misdiagnoses of skull fractures in pediatric emergency cases?

Çekdemir¹

2020

Erciyes Med J

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Objective: To investigate whether three-dimensional (3-D) reformatted cranial computed tomography (CT) scans may contribute to the avoidance of misdiagnosis of skull fractures in pediatric emergency cases. Materials and Methods:This cross-sectional medical chart review was carried out in the pediatric emergency department of a tertiary care center. Data were derived from pediatric age group patients having head trauma patients whose conventional CT images were obtained at initial admission. Demographic, clinical, and radiological data, the location of the fracture, and possible causes of misdiagnoses were recorded. Results:This study included 27 children (21 males and six females). The average age was 41.92±43.25 (range, 1 to 137) months. The most common etiology for admission to the hospital was fall from height (85.2%). The fractures were detected on the parietal (n=12, 44.4%), frontal (n=7, 25.9%), occipital (n=7, 25.9%) and temporal (n=1, 3.7%) bones. In 12 cases (44.4%), skull fracture could not be detected at their initial admission. Five of these 12 cases were consulted to the radiologist, and diagnosis could not be established even by the radiologist. In 15 pediatric head trauma patients (55.6%), the skull fracture was confirmed by the radiologist. In two cases with an initial failure of diagnosis, 3-D reconstruction allowed the identification of fractures. Conclusion:The findings obtained in this study suggest that 3-D reconstruction of CT scans may increase the accuracy of diagnosis for pediatric skull fractures.

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Section: Discussionmentioning

confidence: 99%

Can three-dimensional reformatted computed tomography scans be useful to avoid misdiagnoses of skull fractures in pediatric emergency cases?

Çekdemir¹

2020

Erciyes Med J

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“…Indications for surgical intervention for cranial fractures are based upon either the fracture characteristics or the presence of intracranial bleeding [1,11]. Characteristics requiring surgical intervention include compound fracture, a depression thick enough to damage underlying tissue, and the presence of significant intracranial hematoma or hemorrhage [1,2]. Bullock et al recommended assessing EDH size, GCS at presentation, and pupillary abnormalities to determine when surgery is appropriate, and established that GCS less than 9 and anisocoria associated with EDH at presentation are indications for immediate surgical intervention [11].…”

Section: Discussionmentioning

confidence: 99%

“…Operative planning and management of comminuted and depressed cranial fractures is complex, varying by fracture and location. Surgery is often required for compound or depressed fractures significant enough to damage underlying tissue, and when intracranial hematoma or hemorrhage is present [1,2]. Inherent to surgical management of cranial trauma is management of associated intracranial hemorrhage (ICH) with subsequent establishment of hemostasis.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of Complex Cranial and Orbit Fractures with Associated Hemorrhages: Case Report and Review of the Literature

Caras

Alexander

Young

et al. 2020

Cureus

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We present our experience following a unique case of coincident intracranial hemorrhage and comminuted fractures of both the squamous temporal bone and zygomaticofrontal orbit. Surgical techniques and outcome for this presentation have yet to be sufficiently described. A 55-year-old male presented following trauma with Glasgow Coma Scale score of 7. Radiographic evaluation revealed comminuted fractures of the squamous temporal bone with extension into the lateral orbit, along with zygomatic process fracture extending 2.5 cm medially into the orbital roof. Zygomaticofrontal orbital roof fragments reached superiorly into the middle cranial fossa and inferiorly into the orbit. Surgical intervention was deemed necessary to address underlying epidural hematoma, subarachnoid hemorrhage, correction of cranial bone defects, and decompression of the optic nerve and other intraorbital nerves. A frontotemporal approach was employed. Repair of temporal and orbital fractures was accomplished using a combination of wire mesh screws and titanium miniplates. Postoperative imaging demonstrated bony approximation and successful evacuation of traumatic hemorrhage. The patient remains functionally and neurologically intact apart from a sluggishly responsive left eye presumed to result from a left optic nerve or ciliary ganglion lesion. Although rapid reconstruction of complex cranial-orbital trauma and hematoma evacuation can permit acceptable gross functional neurological outcome following massive trauma, orbital fracture and subsequent hemorrhagic processes may be the nidus of neurological sequelae in this complex traumatic constellation. Thus, alterations in surgical approach and reconstruction are appropriate in order to maximize neurological function while supporting restoration of cosmetic space.

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“…However, indications for surgery vary from depth of depression to location. 2 Timing of surgery does not seem to make a difference to outcomes either. 9 The evidence base for management of open and closed depressed skull fractures is sparse and almost entirely consists of case reports and series'.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Variations in the Neurosurgical Management of Depressed Skull Fractures in Adults: An International Cross-Sectional Survey

Suliman

Jayakumar

Chaurasia³

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Aims Depressed skull fractures have been well-described since antiquity, yet its management remains controversial. Contentious issues include the use of prophylactic antibiotics and antiepileptics, the role of non-operative management, and the replacement/removal of bone fragments. Our objective was to explore the management patterns of closed and open depressed skull fractures across the world. Material and Methods A 23-item, web-based survey was distributed electronically to the members of national neurosurgical associations, and on social media platforms. The survey was open for data collection from December 2020-April 2021. Statistical calculations were performed with SPSS v22 (IBM). Results A total of 218 respondents completed the survey, representing 56 countries. With regards to open fractures, most respondents (85.8%) treated less than 50 cases annually. Most respondents (79.4%) offered prophylactic antibiotics to all patients with open fractures, with significant geographical variation (p<0.001). Less than half (48.2%) offered prophylactic antiepileptics. Almost all (>90%) reported the following indications as important for surgical management: (1) grossly contaminated wound; (2) dural penetration; (3) depth of depression; and (4) underlying contusion/haematoma with mass effect. Most respondents treated less than 50 cases of closed depressed skull fractures annually. Most European respondents (81.7%) did not offer prophylactic antiepileptics in comparison to most Asian respondents (52.7%) (p<0.001). Depth of depression, an underlying haematoma/contusion with mass effect, and dural penetration were the most important surgical indications. Conclusions There remains a great degree of uncertainty in the management strategies employed across the world in treating depressed fractures, and future work should involve multi-national randomised trials.

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The Evolution of Modern Treatment for Depressed Skull Fractures

Cited by 31 publications

References 68 publications

Can three-dimensional reformatted computed tomography scans be useful to avoid misdiagnoses of skull fractures in pediatric emergency cases?

Can three-dimensional reformatted computed tomography scans be useful to avoid misdiagnoses of skull fractures in pediatric emergency cases?

Reconstruction of Complex Cranial and Orbit Fractures with Associated Hemorrhages: Case Report and Review of the Literature

Variations in the Neurosurgical Management of Depressed Skull Fractures in Adults: An International Cross-Sectional Survey

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