Written by Dr. Abdul Aziz Salar, MBBS | 
Medically Reviewed by dr. simi paknikar, MD on Nov 06, 2014

Diagnosis and Treatment of Skull Fractures

Diagnosis of Skull Fractures

Skull fractures are diagnosed based on physical examination and imaging studies like CT scans.


In most cases, the diagnosis of skull fractures is straight forward.

  • In almost all cases of trauma, the ATLS (Advanced Trauma Life Support) protocol is used to quickly assess the patient and to provide specialized emergency care if required.
  • A thorough physical examination focusing on the skull, and all other parts of the body to rule out other injuries is essential.
  • A CT scan is often ordered to precisely identify the site, extent and complications of the fracture.
  • 3D CT scans are now used extensively for their accuracy and ease of interpretation.
  • X ray of the skull may also be taken as an alternative, when CT facility is lacking.
Diagnosis of Skull Fractures: X-ray
  • MRI of the brain is done if complications to the soft tissues are suspected.
  • Routine blood investigations are done to rule out infections and if some underlying pathology is suspected.
  • Tests for CSF leak from basilar fractures include– “halo” sign on a tissue paper, glucose and tau-transferrin levels in the fluid.

Treatment of Skull Fracture and Recovery

Treatment of skull fractures depends on the type, severity and complications of the fracture. Most mild fractures are managed conservatively. Fractures causing complications are treated surgically.

In any case of skull fracture, the primary aim of treatment is to stabilize the patient. After stabilization, the decision of which treatment, if any, for the skull fracture, is taken. Majority of skull fractures do not require any specific treatment. The decision to treat a patient specifically for a skull fracture depends on various issues, such as the type, severity and complications of the fracture, as well as the age and overall health of the patient. Medical treatment for all types of fractures includes reducing pain, promoting healing and preventing complications, and tetanus toxoid injection to prevent tetanus infection.

Treatment for specific types of fractures is as follows:

  • 1. Linear fractures
    • Adults with simple linear fractures, with no complications may not need any specific treatment.
    • Children with simple fractures need to be admitted and observed for complications.
  • Depressed fractures may lead to neurological symptoms and are hence more often managed surgically. Elevation of the depressed fraction of the skull is performed. On some occasions, if the underlying brain is damaged, craniectomy is performed, followed by cranioplasty later.
Treatment of Skull Fractures: Surgery
  • Basilar fractures that cause loss of CSF from the nose may heal spontaneously. If the CSF leak is large, or sustained for a long time, a drainage tube may be inserted or surgical correction may be done.
  • Comminuted fractures are treated surgically if the fragments of the fracture are displaced, or cause symptoms.

In all complicated and/or unstable fractures, treatment must be directed at the complications also.

Recovery from skull fractures

Recovery to full functional status is usually the norm, if there is no neurological damage or other complications

Recovery from Skull fractures
  • Post-injury concussions usually resolve spontaneously on their own. Sometimes, they may persist for weeks
  • Neurological deficit due to fractures is a very difficult complication to handle. If the deficit is due to pressure on the nerve, it may resolve on its own. If the deficit is due to a cut of the nerve, the function of the nerve may be permanently lost
  • Direct brain damage by skull fracture may also cause potentially debilitating long term effects.

References:

  1. Skull Fractures - (https://www.healthline.com/health/skull-fracture#Overview1)
  2. Skull Fracture - (https://emedicine.medscape.com/article/248108-overview)
  3. Basal skull fracture and the halo sign - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602259/)

Comments

Moavia Friday, December 26, 2014

I had head injury in April 2008 and suffered loss of memory but recovered soon. The fol symptoms still persist

a. I have lost my concentration to an extent that i have to focus my self deliberately to understand 4 lines script and to assimilate it while before the injury i used to have glimpses of any script and comprehension of it immediately

b. My retention power is almost lost i have to work so hard to memorize something

c. i have developed stiff neck forever around the neck pain feel like muscles stiffened even on right shoulders

Plz guide me if there is a solution

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