Summary
Definition
History and exam
Key diagnostic factors
- risk factors
- open fracture
- palpable discrepancy in bone contour
- Battle's sign
- periorbital ecchymosis
- bloody otorrhoea
- cerebrospinal fluid rhinorrhoea
- facial paralysis, nystagmus, or paraesthesia
Other diagnostic factors
- evidence of trauma
- cranial pain or headache
- nausea/vomiting
- altered mental state/loss of consciousness
- abnormal pupillary reflexes
- hearing loss
Risk factors
- fall from height
- motor vehicle accident
- assault resulting in head trauma
- gunshots to the head
- male sex
Diagnostic investigations
1st investigations to order
- cranial CT
Investigations to consider
- skeletal survey
- MRI
- MR angiography
- beta-2 transferrin assay
- plain skull x-ray
- clotting screen
Treatment algorithm
suspected skull fracture (any type)
confirmed closed non-depressed fracture
confirmed closed depressed fracture
confirmed open fracture
persistent cranial nerve injury or CSF leakage
Contributors
Expert advisers
Demetrios Demetriades, MD, PhD, FACS
Professor of Surgery
Director
Division of Trauma and Surgical Intensive Care
LAC+USC Trauma Center
Keck School of Medicine at USC
University of Southern California
Los Angeles
CA
Disclosures
DD declares that he has no competing interests.
Leslie Kobayashi, MD, FACS
Associate Professor of Surgery
Division of Trauma, Surgical Critical Care and Burns
University of California San Diego
San Diego
CA
Disclosures
LK declares that she has no competing interests.
Disclosures
Peer reviewers
Kevin Tsang, MBBS, BSc (Hons), MRCS (Eng), FRCS (SN)
Consultant Neurosurgeon
Unit Training Lead and Clinical Teacher
Imperial College Healthcare NHS Trust
London
UK
Disclosures
KT declares that he has no competing interests.
Editors
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
Disclosures
TAO declares that she has no competing interests.
Jo Haynes
Head of Editorial, BMJ Knowledge Centre
Disclosures
JH declares that she has no competing interests.
Annabel Sidwell
Comorbidities Editor, BMJ Best Practice
Disclosures
AS declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
Differentials
- Intracranial haemorrhage
- Suture lines in children
- Cephalhaematoma
More DifferentialsGuidelines
- Head injury: assessment and early management
- Clinical practice guideline for paediatric head injury
More GuidelinesCalculators
Glasgow Coma Scale
More CalculatorsLog in or subscribe to access all of BMJ Best Practice
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