Summary
Definition
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
- nausea
- 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
- MRI
- MRI angiography
- beta-2 transferrin assay
- audiogram
- cranial ultrasound
- plain skull x-ray
- skeletal survey
- CT angiogram
- CT venogram
Treatment algorithm
closed nondepressed fracture
closed depressed fracture
open fracture
persistent cranial nerve injury or CSF leakage
Contributors
Authors
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.
Peer reviewers
Tunji Lasoye, FRCS, FCEM, MA, Med Ed
Consultant and Honorary Senior Lecturer in Emergency Medicine
Clinical Lead
Emergency Department
Director of Medical Education
King's College Hospital
London
UK
Disclosures
TL declares that he has no competing interests.
Micelle J. Haydel, MD
Program Director
LSU Emergency Medicine Residency
Louisiana State University
New Orleans
LA
Disclosures
MJH declares that she has no competing interests.
Thomas Scalea, MD
Physician in Chief
R Adams Cowley Shock Trauma Center
Francis X. Kelly Professor of Trauma Surgery
University of Maryland School of Medicine
Baltimore
MD
Disclosures
TS declares that he has no competing interests.
Differentials
- Intracranial hemorrhage
- Suture lines in children
- Cephalhematoma
More DifferentialsGuidelines
- Head injury: assessment and early management
- Guideline on the diagnosis and management of mild traumatic brain injury among children
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