|The surgical treatment for skull fractures has been described in Edwin Smith's Papyrus, which is an ancient Egyptian medical treatise on surgery that was acquired by Edwin Smith in 1862.|
The human body has five types of bones: long, short, flat, irregular, and sesamoid. The flat bones often provide protection to the soft tissues that are located beneath them. These bones comprise a thick outer layer (table of bone), spongy bony tissue (diploe), and an inner layer (inner table). The bones of the skull come under this category. The cranial bones provide protection to the brain and other anatomical structures in the head. The skull comprises small frontal, parietal, temporal, occipital, sphenoid, and ethmoid bones. For the skull to get fractured, a significant amount of force that exceeds the elastic limit of the bone has to be applied. Besides the force applied, the determining factors also include the direction and point of impact. Blunt force trauma is often the main contributing factor for head injuries or traumatic brain injuries.
Though the cranial bones protect the brain from trauma, the skull doesn't absorb the impact. The impact from the blow often gets transmitted to the brain. It must be noted that a fracture may or may not be accompanied by brain damage. Though uncomplicated, simple/closed fractures (fractures characterized by a break in the bone without damage to the skin) or linear fractures might not require treatment, surgical intervention is required for fractures that are associated with an increased risk of brain damage. These include open/compound fractures wherein a break in the skin exposes the brain to pathogens and harmful foreign matter, or fractures wherein bones break and get displaced.
Diagnosis and Treatment of Skull FracturesThe common contributing factors for skull bone fractures include head trauma due to falls, physical assault (blunt or penetrating force trauma), automobile accidents, or sports-related injuries. A fracture can be diagnosed with the help of the following diagnostic procedures:
❖ An X-ray examination
❖ CT scan
❖ Electroencephalogram (EEG)
❖ Electromyography (EMG)
❖ Cerebral arteriography
❖ Eye/ear examination
❖ Glasgow coma scale (for checking reflexes, pupil reaction to light, responses to stimuli, and level of consciousness)
Treatment Options for Different Types of Fractures
Skull fractures are of the following types:
This is one of the common types of skull fractures. In this type, imaging tests will show a thin crack or break in a bone that resembles a line. The bone doesn't move from its place.
Both simple and linear types are of little clinical significance. The crack is most likely to resolve on its own. However, the affected individual would be treated for the external head wound. Drug therapy that involves the use of analgesics, antibiotics, or steroids might be recommended.
As the name suggests, this type of fracture is characterized by a depression in the skull, wherein a part of the skull gets depressed or pushed inward due to the force of the impact. If the fragments of the bone bend in towards the brain, the brain is likely to get damaged. If left untreated, one could even develop an infection in the brain.
The treatment involves drug therapy. The treatment options are suggested, depending on the extent of depression and the accompanying symptoms. The risk of brain damage is more likely in case of a deeper depression, bleeding within the skull, and open wounds. Surgical intervention is considered if:
❖ The depression is greater than the thickness of the skull, i.e., more than 8-10 mm.
❖ There's a leakage of cerebrospinal fluid (CSF).
❖ Brain damage or pressure on the brain is suspected.
❖ There is a visible cut on the scalp exposing the fracture.
In such cases, surgery is performed to elevate the depressed bone and secure it with plates and rivets. Injuries or bleeding are also treated during the surgery. If a bone fragment is damaged, cranioplasty is recommended to repair the defect. A lumbar drain might be recommended in case of increased pressure due to the buildup of CSF. This is achieved by putting a tube in the lower back for draining out CSF. A spinal tap can also be conducted to extract a sample of CSF or drain the fluid.
In this type of fracture, the break in the bone occurs at the base of the skull. A person with this type of fracture might have bruises around the eyes or behind their ear. The bruises develop when fluid leaks from the outermost brain membrane called dura. If there is a tear in the dura, this clear fluid might drain from the nose or ears.
In case of fractures that cause the meninges to tear, there is an increased risk of meningitis. Therefore, the treatment might involve drug therapy. Usually, the patient is hospitalized and kept under observation. If CSF leakage continues even after 48 hours, surgical intervention is required to stop the leakage.
An occipital bone fracture is said to occur when the saucer-shaped bone at the base of the skull gets fractured. Surgery is recommended for the treatment of a broken occipital bone, as it is associated with an increased risk of complications.
This refers to a complex fracture with bone splintering and tearing of the skin. Sometimes, the skull bone might break into various fragments. Problems can arise, if the fragments get dislodged and penetrate the outermost layer of the brain.
Surgical intervention becomes necessary to align or remove the fragments that get dislodged. Besides these treatment options, the use of a halo traction or neck brace might be recommended, so as to lower the risk of injuries that could occur due to the sudden movements of the head or neck.
Symptoms to Watch Out for
The symptoms might vary, depending on the type of fracture. Medical assistance must be sought, if a head injury gives rise to the following symptoms:
❖ Bump on the head
❖ Bleeding from the wound
❖ Bruising behind ears or under the eyes
❖ Vision-related problems
❖ Bleeding from ears or nose
❖ Difficulty in balancing
❖ Changes in pupils
❖ Loss of consciousness
Thus, the treatment depends on the type of injury and the associated symptoms. For instance, in case of infants affected by head trauma, the membranes that surround the brain might protrude. As a result, cerebrospinal fluid might accumulate and lead to the formation of a leptomeningeal cyst or a growing fracture. Such a cyst can put pressure on the infant's brain or cause infection. In this case, the treatment generally involves the drainage of such cysts.
Minor head injuries that result in a simple skull hairline fracture or a linear fracture don't really require extensive treatment, as the crack can heal on its own. However, certain fractures can cause brain damage, which is why prompt treatment will be required. Surgery is often recommended in case of severe fractures. The treatment often requires the removal of damaged tissues, drainage of blood, and alignment of skull fragments. Due to the impending risk of brain damage, medical help must be immediately sought in case of such fractures.
Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.