Skull fractures commonly result from a fall, a traffic accident, or an assault.
Skull fractures may be linear or comminuted with multiple fracture lines, may be located on the cranial vault or in the basilar skull, may have a varying degree of depression or elevation, and can be open or closed. Open fractures communicate with the skin through a wound, a sinus, the ear, or the oropharynx.
Computed tomography, with thin axial cuts, remains the imaging modality of choice. With basilar skull fractures, 3D reconstructions are useful.
May be associated with other significant injuries, most importantly intracranial hemorrhage.
For isolated skull fractures, treatment is primarily conservative.
Surgical intervention is determined not by the fracture per se but by the extent of the associated intracranial pathology, cranial nerve deficit, or cerebrospinal fluid leak.
Skull fracture refers to a fracture of one or more bones of the cranial vault or skull base. Skull fractures are categorized according to the appearance, location, degree of depression, and if they are open or closed. Open fractures communicate with the skin through a wound, a sinus, the ear, or the oropharynx. Skull fractures may be linear or comminuted; comminuted fractures are complex with multiple fracture lines.
History and exam
Key diagnostic factors
- open fracture
- palpable discrepancy in bone contour
- Battle sign
- periorbital ecchymosis
- bloody otorrhea
- cerebrospinal fluid rhinorrhea
- facial paralysis, nystagmus, or paresthesia
Other diagnostic factors
- evidence of trauma
- cranial pain or headache
- altered mental state/loss of consciousness
- abnormal pupillary reflexes
- hearing loss
- fall from height
- motor vehicle accident
- assault resulting in head trauma
- gunshots to the head
- male sex
1st investigations to order
- cranial CT
Investigations to consider
- MR angiography
- beta-2 transferrin assay
- cranial ultrasound
- plain skull x-ray
- skeletal survey
- CT angiogram
- CT venogram
closed nondepressed fracture
closed depressed fracture
persistent cranial nerve injury or CSF leakage
- Intracranial hemorrhage
- Suture lines in children
- ACR Appropriateness Criteria: head trauma
- ACR Appropriateness Criteria: head trauma - child
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