Skull fracture 2593831 219450035 2008-06-15T08:03:08Z Lipothymia 334443 /* Comminuted fracture */ {{DiseaseDisorder infobox | Name = Skull fracture | Image = Depressed skull fracture.jpg | Caption = A piece of a skull with a depressed skull fracture | ICD10 = S02 | ICD9 = {{ICD9|800.0}}-{{ICD9|804.9}} | }} A '''skull fracture''' is a break in one or more of the bones in the [[skull]] caused by a [[head injury]]. Isolated skull fractures are not very serious injuries, but the presence of a skull fracture may indicate that significant enough impact occurred to cause [[brain trauma]], which is quite serious. Broken fragments of skull can [[lacerate]] or [[brain contusion|bruise the brain]] or damage [[blood vessel]]s. If the fracture occurs over a major blood vessel, significant bleeding can occur within the skull, so [[head injury]] patients with skull fracture have many more [[intracranial hematoma]]s (especially [[epidural hematoma]]s) than those without fractures.<ref name="singh"/><ref name="Graham and Gennareli">Graham DI and Gennareli TA. Chapter 5, "Pathology of Brain Damage After Head Injury" Cooper P and Golfinos G. 2000. Head Injury, 4th Ed. Morgan Hill, New York. </ref> Another complication of skull fractures is [[dissected artery|dissection]] of [[cerebral artery|cerebral arteries]], which can limit [[Cerebral blood flow|blood flow to the brain]]. However, the bone fracture helps dissipate energy from a blow, so less force is transmitted to the brain, so having a skull fracture is not a good predicter of intracranial injury.<ref name="ropper">{{cite journal |author=Ropper AH, Gorson KC |title=Clinical Practice. Concussion |journal=New England Journal of Medicine |volume=356 |issue=2 |pages=166–172 |year=2007|url=http://content.nejm.org/cgi/content/full/356/2/166/T1 |pmid=17215534 |doi=10.1056/NEJMcp064645 |accessdate=2008-01-16}}</ref> A fracture in which the skin is also broken is called an [[open fracture]] or compound fracture. [[Penetrating head injury|Penetrating head injuries]] are those that cause a fracture in the skull and breach the [[dura mater]], the outermost membrane of the brain's [[meninges]]. Fractures of the skull can be [[comminuted fracture|comminuted]], depressed, linear or diastatic.<ref name="singh"/> ==Linear fracture== '''Linear skull fractures''', the most common type of skull fracture, occur in 69% of patients with severe head injury.<ref name="Gilbert">Gilbert S. 1969. [http://members.aol.com/SVG2254/coup_html.html "Investigative Significance of Coup and Contrecoup Head Injuries."] Retrieved on [[January 26]], [[2007]].</ref><ref name="Graham and Gennareli"/> Usually caused by widely distributed forces, linear fractures often occur when the impact causes the area of the skull that was struck to bend inward, making the area around it buckle outward.<ref name="Gilbert"/><ref name="Graham and Gennareli"/> In rare cases, a linear fracture can develop and lengthen as the [[cerebral edema|brain swells]], in what is called a '''growing fracture'''. This can cause growth of [[cyst]]s in the [[meninges]].<ref name="Graham and Gennareli"/><ref name="Orlando Regional">Orlando Regional Healthcare, Education and Development. 2004. [http://www.orlandoregional.org/pdf%20folder/overview%20adult%20brain%20injury.pdf "Overview of Adult Traumatic Brain Injuries."] Retrieved on [[January 26]], [[2007]].</ref> '''Diastatic fractures''' are linear fractures that cause the bones of the skull to separate at the [[skull suture]]s in young children whose skull bones have not yet fused.<ref name="BAIUSA">Brain Injury Association of America (BIAUSA). [http://www.biausa.org/Pages/types_of_brain_injury.html#diffuse "Types of Brain Injury."] Retrieved on [[January 26]], [[2007]].</ref><ref name="Orlando Regional"/> They are usually caused by impact with a wide area such as a wall.<ref name="Gilbert"/> ==Comminuted fracture== [[Image:Elevating depressed skull fracture.jpg|thumb|170px|right|An illustration from a 1517 book depicting a method used at the time to lift a depressed skull fracture. The patient has weakness on the left side of the face and palsies of the right [[Oculomotor nerve|oculomotor]] and [[hypoglossal nerve]]s.]] '''Comminuted skull fractures''', those in which a bone is shattered into many pieces, can result in bits of bone being driven into the brain, [[laceration|lacerating]] it.<ref name="Gilbert"/> '''Depressed skull fractures''', a very serious type of [[Physical trauma|trauma]] occurring in 11% of severe head injuries, are comminuted fractures in which broken bones are displaced inward.<ref name="Graham and Gennareli"/> This type of fracture carries a high risk of increasing [[intracranial pressure|pressure on the brain]], crushing the delicate tissue. Complex depressed fractures are those in which the [[dura mater]] is torn. Depressed skull fractures may require [[neurosurgery|surgery]] to lift the bones off the brain if they are causing pressure on it.<ref name="singh">Singh J and Stock A. 2006. [http://www.emedicine.com/ped/topic929.htm "Head Trauma."] Emedicine.com. Retrieved on [[January 26]], [[2007]].</ref> One example of this type of fracture occurred on [[October 14]], [[2006]] to goal keeper [[Petr Čech]] during an English [[football (Soccer)|football]] match. He was immediately escorted off the field and required emergency [[neurosurgery|surgery]].<ref name="soccer">ESPN Soccernet. 2006.[http://soccernet.espn.go.com/news/story?id=385554&cc=5901 "Chelsea's Cech has surgery for skull fracture".]</ref> ==Basilar skull fracture== {{main|Basilar skull fracture}} [[Basilar skull fracture]]s, breaks in bones at the base of the skull, require more force to cause than cranial vault fractures. Thus they are rare, occurring as the only fracture in only 4% of severe head injury patients.<ref name="Graham and Gennareli"/><ref name="Orlando Regional"/> Basilar fractures have characteristic signs: blood in the [[Paranasal sinus|sinuses]]; a clear fluid called [[cerebrospinal fluid]] (CSF) leaking from the nose or ears; [[raccoon eyes]] (bruising of the orbits of the eyes that result from blood collecting there as it leaks from the fracture site); and [[Battle's sign]] (caused when blood collects behind the ears and causes bruising). ==References== {{reflist|2}} ==External links== * Downie A. 2001. [http://www.radiology.co.uk/srs-x/tutors/cttrauma/tutor.htm "Tutorial: CT in Head Trauma"] Retrieved on [[January 25]], [[2007]]. * Shepherd S. 2004. [http://www.emedicine.com/med/topic2820.htm "Head Trauma."] Emedicine.com. Retrieved on [[January 26]], [[2007]]. * [http://rad.usuhs.edu/medpix/parent.php3?mode=image_finder&action=search&srchstr=skull%20fracture&srch_type=all#top Skull Fractures] MedPix Images {{Fractures}} [[Category:Bone fractures]] [[Category:Neurotrauma]]