Skull fractures

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. They 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.[Figure caption and citation for the preceding image starts]: Linear parietal fracture without depressionFrom the teaching collection of Demetrios Demetriades; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Axial CT scan demonstrating an open nondepressed linear skull fracture (arrow) associated with pneumocephalus (circle)From the teaching collection of Demetrios Demetriades; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Axial CT scan showing nondepressed linear skull fracture (arrow) of the skull base involving the foramen magnum. This injury pattern is concerning for associated spinal fracture, cord injury, and blunt cerebrovascular injuryFrom the teaching collection of Demetrios Demetriades; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Comminuted nondepressed fractureFrom the teaching collection of Demetrios Demetriades; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Comminuted depressed skull fracture with pneumocephalusFrom the teaching collection of Demetrios Demetriades; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Comminuted depressed fracture of the frontal sinus with air, fluid, and bone fragments in frontal sinus and pneumocephalus; level of depression greater than width of cortexFrom the teaching collection of Demetrios Demetriades; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Depressed skull fracture: level of depression equal to thickness of cortexFrom the teaching collection of Demetrios Demetriades; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Axial CT scan demonstrating open elevated linear skull fracture (large arrow). Note the air in the soft tissues (small arrow), the small amount of pneumocephalus associated with the fracture (circle), and that the level of elevation of the bone fragment is significantly more than the thickness of the bony tableFrom the teaching collection of Demetrios Demetriades; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Sagittal CT images of an open, comminuted, depressed skull fracture. Note the associated pneumocephalus (small arrows). The level of depression is greater than the bony table and there are a number of bone fragments impacted below the inner cortex of the opposing bone (large arrow). Despite lack of underlying associated brain injury this fracture required operative debridement and elevation of the bone fragments. See also the corresponding coronal CT imageFrom the teaching collection of Demetrios Demetriades; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Coronal CT of an open, comminuted, depressed skull fracture. The level of depression is greater than the bony table and there are a number of bone fragments impacted below the inner cortex of the opposing bone (large arrow). Despite lack of underlying associated brain injury this fracture required operative debridement and elevation of the bone fragments. See also the corresponding sagittal CT imageFrom the teaching collection of Demetrios Demetriades; used with permission [Citation ends].