Linear fracture of the skull
Fractures of the cranial vault are divided into several types:
- Impressed, in which a broken bone is pressed into the skull. The consequence of this can be damage to the dura mater, blood vessels and medulla, the formation of extensive hematomas;
- Comminuted, in which the bone disintegrates into several fragments that damage the structures of the brain, and the same consequences appear as with a depressed fracture;
- Linear, least dangerous, in which the damage to the cranial bone looks like a thin crack.
With a linear fracture, the displacement of the bone plate is absent or is no more than 1 cm. The bones in this type of fracture can heal without serious complications and consequences. However, the formation of epidural (between the inner surface of the bone and the meninges) hematomas is possible due to internal hemorrhage, which increase gradually and make themselves felt only 1.5-2 weeks after the injury, when the victim is already in a rather serious condition.
Linear fractures account for 80% of skull fractures, especially in children.
In most cases, the parietal bone is damaged, sometimes the frontal and occipital are captured. If the fracture line crosses the cranial suture lines, this indicates a significant force on the head and a high probability of damage to the dura mater. In this regard, there is such a type of linear fracture as diastatic ("gaping"), which is characterized by the transition of the fracture line to one of the cranial sutures (most often found in young children).
Content:
- Causes of a linear fracture of the skull
- Symptoms of a linear skull fracture
- Diagnostics of the linear skull fracture
- Treatment of a linear skull fracture
Causes of a linear fracture of the skull
Such a fracture usually occurs as a result of being hit by an object with a large area. Traces of mechanical impact (abrasion, edema) are usually present above the fracture site.
Skull fractures can be: direct, indirect. In a straight line, the bone is deformed directly at the site of impact; in an indirect one, the impact is transmitted from other damaged bones. Unlike skull base fractures, vault fractures are in most cases straight.
Symptoms of a linear skull fracture
A wound or hematoma is found on the scalp, while bone depression felt on palpation is absent.
Common signs of any fracture include:
- Severe headaches;
- Nausea, vomiting;
- Lack of pupil response;
- Respiratory and circulatory disorders in case of compression of the brain stem;
- Confusion or loss of consciousness.
Diagnostics of the linear skull fracture
To make a diagnosis, the craniography method is used (X-ray examination of the skull without the use of a contrast agent). In some cases, cracks can extend through multiple bones. When examining the images, special attention should be paid to the intersection of the vascular grooves by the fissure, since this can damage the intracranial vessels and sheathing arteries, which causes the formation of epidural hematomas. Sometimes the edges of the hematoma can be compacted and raised, which gives the impression of a depressed fracture on palpation.
Sometimes in medical practice there are mistakes when the shadow of the vascular groove is taken for an incomplete fracture (crack). Therefore, it is necessary to take into account the location of the arterial grooves and the specifics of their branching. They always branch in a certain direction, their shadows are not as sharp as fracture lines.
A linear fracture on an X-ray image has the following distinctive features:
- The fracture line is black;
- The fracture line is straight, narrow, without branching;
- The vascular groove is gray, wider than the fracture line, tortuous, with branching;
- The cranial sutures are gray and of considerable width, with a standard stroke.
In 8-10 days after TBI, cracks in the bones are more pronounced than immediately after injury.
Treatment of a linear skull fracture
In the absence of intracranial hematomas and damage to the brain structures, linear fractures do not require surgical intervention and require only supportive therapy, which includes wound treatment and taking light painkillers. In case of loss of consciousness, the victim is monitored in a medical facility for at least 4 hours. If, as a result of an examination by a neurosurgeon, it is found that vital functions are not impaired, the patient can be released under home supervision.
For several weeks after injury, the fracture area fills with fibrous tissue. If the fracture line is narrow enough, then it ossifies. The ossification process lasts about 3-4 months in children and up to 2-3 years in adults. If the crack width exceeds a few millimeters, then bone bridges are formed in the fibrous tissue filling it.
Fissures of the cranial vault are also subject to conservative treatment, which continue to its base, but do not pass through the walls of the nasal airways, pyramids and cells of the mastoid processes.
The indication for surgery is the displacement of the bone plate, as a result of which it protrudes above the surface of the cranial vault by more than 1 centimeter. In this case, there is a high risk of damage to the meninges and other brain tissues, which can lead in the future to such long-term consequences as epilepsy.
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If this fracture occurred in a child under the age of three and was accompanied by a rupture of the dura mater, then in the future, the edges of the fracture line may spread wider and a linear skull defect is formed. The arachnoid membrane, filled with cerebrospinal fluid, begins to protrude, and the bones gradually diverge even wider. In this case, plastic surgery is recommended.
In most cases, a linear fracture heals without any special consequences for the victim, but, like any other fracture of the skull bones, it can provoke the development of hypertension.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
