Depressed skull fracture
Content:
- What is a depressed skull fracture?
- What happens during a depressed skull fracture?
- Symptoms of a depressed skull fracture
- Possible complications and their prevention
- Diagnostics
- Treatment of depressed skull fractures
- Forecast
What is a depressed skull fracture?
Fractures in which bone fragments are displaced below the cranial vault are called depressed fractures. These fractures cause compression of the brain.
There are two types of fractures:
- impression, when bone fragments are associated with whole areas;
- depressive, when damaged bones break off and lose their connection with the cranial surface.
Fractures can occur in two ways:
- When striking a fixed head with an object with a striking surface, it is smaller than the vault of the skull.
- When a person falls onto an object with a small surface.
What happens during a depressed skull fracture?
There are many options for fractures, this is explained by the ratio of the areas of the striking surface and the cranial vault, whether the head was moving at that moment, the shape of the injuring object, the elasticity of the bones, the presence of a headdress.
Common types of damage:
- A small impacting surface moving at high speed will leave impression fractures without damaging the scalp. Whether the fracture is penetrating depends on how much the dura mater is accreted to the bone.
- When struck with a narrow object on a motionless head, brain damage is limited to the epicenter of the impact.
- A blow to the head when falling from a height is accompanied by an additional linear fracture.
- A special type of impression is the split of the cranial plates, when the inner plate forms a depressed fracture. Such a fracture occurs if the impact surface is blunt.
- When struck with force by a large object, the fragments are pressed into the cranial cavity. Brain damage occurs at the epicenter of the stroke.
- The type of depressed fracture depends on the type and site of exposure. Thinning bone surfaces are most vulnerable. Here, deep indentation has minimal manifestation.
- A depressed fracture of the base of the skull is rare, but when it occurs, a penetrating fracture is usually formed.
At a young age, fractures are often impression, the meninges are rarely damaged. In infants, depression of the skull bones is observed without the formation of a fracture. This is due to the elasticity of the bones of the skull. In old age, fractures with the formation of many fragments, which are of a penetrating nature, are frequent.
Symptoms of a depressed skull fracture
Compression of the skull is characterized by the manifestation of symptoms from almost all systems.
Neurological symptoms appear depending on the location of the impression. The severity of the injury is determined by the extent of the compression of the brain. The symptomatology is blurred, convulsions occur only when the frontal lobe is affected. The symptomatology of prolapse is present mainly with hemorrhage.
With a depressed fracture, large blood vessels are compressed, which leads to an epidural hematoma. There is paresis in the foot or hand, a violation of the outflow of cerebrospinal fluid, leading to hydrocephalus. There are pains of a hypertensive nature, dizziness, hearing and vision decrease.
Somatic disorders: shock, hypotension, fat embolism.
Possible complications and their prevention
-
Scar of soft tissues. Prevention includes the use of a sharp scalpel, wound dressing and debridement.
- Suppuration processes leading to a brain abscess. Prevention consists of freeing bones from foreign bodies and blood clots.
- Cerebral scar, wound liquorrhea provoking epileptic seizures. Prevention is reduced to wound treatment, if necessary, prosthetic membranes are used.
Diagnostics
If the victim has a gaping wound, a fracture is easily diagnosed. With closed head injury, diagnosis is difficult even with deep depressions. Palpation is unacceptable, otherwise the fragments may shift.
The best method is X-ray diagnostics, which gives an idea of the nature of the wound. MRI is a modern diagnostic method that allows you to determine the state of the brain as a whole. Comprehensive information is provided by spiral CT, which determines the wound surface and possible threats.
Treatment of depressed skull fractures
Before hospitalization, it is important to stop the bleeding by applying a pressure bandage so as not to dislodge the fragments. A depressed fracture is treated with surgery. Contraindications to intervention are shock, fat embolism, profuse blood loss. Conservative treatment is possible with a closed fracture, if there is no compression of the meninges.
The basic principles that are followed during treatment:
- Mobilization of fragments with a spherical cutter of small diameter, preserving the area of intact bone.
- Free bone fragments, fixed with an external bone plate, are removed after the plate is bite.
- Multiple depressions are operated using wide trepanation. This allows you to quickly stop bleeding.
- If it is impossible to conduct CT, the meninges are dissected to study the state of the cerebral space. The method is unacceptable if the wound is contaminated.
- If the dura is damaged, the brain space is revised. Prosthetics of the shell is carried out with a polytetrafluoroethylene membrane 3 mm thick.
- The most difficult fracture is considered when sharp fragments invade the cranial cavity, damaging large vessels. Here you need access to the interhemispheric gap, suturing of the hard shell and the introduction of a muscle strip, which can be replaced with a TachoComb plate.
- For any type of depressed fracture, the final stage is the restoration of the skull surface. The best plastic is considered to be a preserved fragment, combining it with the general cover by gluing. The bone is strengthened with titanium plates. If bone fragments are removed, further work with them is possible after thorough disinfection.
- With small fragments that have lost contact with the periosteum, wound contamination or cerebral edema, reconstruction is dangerous. In this case, a dura mater prosthesis is used to seal the wound.
On the subject: 12 popular ways for home treatment
Forecast
Often with depressed fractures, even extensive ones, the general symptoms are mild. The main thing in treatment is to restore blood flow and the integrity of the membranes and integuments. Then the recovery is almost complete. With suppuration of the wound after surgery, prognosis worsens.
Disability grade 3 is established for people who have a bone defect of at least 3x3 cm in size, not covered by bone tissue.
In case of a depressed fracture of the skull, you should immediately contact a neurosurgeon.
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
