Skull Fracture

Skull fracture
Photo Credit: ADAM

A skull fracture is a break in the skull bone. The skull is the bony protective covering of the brain. Different kinds of skull fractures exist but it only takes a strong impact or major blow to the head to cause the skull to break. There may or may not be an accompanying injury.

A fracture may not be visible; however, some symptoms denote a skull fracture and they include:

  • Pain and swelling around the site of impact
  • Bleeding from orifices, nose or ears
  • Facial bruising

The treatment of skull fracture depends on how severe it was. Mild cases may only require pain-relieving medications, while more severe cases would require neurosurgery.

Types of skull fractures

This depends on the force of the blow, the site of impact on the skull, and the shape of the object causing the impact.

Different types of fractures would cause different kinds of injury and trauma. A sharp object is more likely to penetrate the skull than a blunt surface like the ground.

Closed fracture

Here, there is no communication with the broken bone and the external environment. It is a simple fracture.

Open fracture

This is also called a compound fracture. Here, there is communication between the broken bone and the external environment through a break in the skin.

Depressed fracture

This typically leads to an indentation or extension of the skull into the brain cavity.

Basal fracture

This occurs on the floor of the skull, which is the area surrounding the eyes, ears, nose, or even at the superior aspect of the neck near the spine.

Other types

Additionally, skull fractures can also be:

  • Linear: are straight fractures
  • Comminuted: when a bone is broken into 3 or more segments

Causes of skull fracture

A fracture to the skull results from an overwhelming force which is enough to break the skull. Any form of impact can cause a skull fracture. Activities such as a car accident where the skull is hit, being hit with an object, or a gunshot injury to the head can all cause a skull fracture.

Symptoms of skull fracture

When the type of fracture is either an open fracture or a depressed fracture, the skull can be seen to be broken.

Other times where the fracture isn’t seen, the following symptoms and signs may be indicative of a skull fracture:

  • Bleeding from craniofacial orifices including the eyes, ears, nose and trauma site
  • Bruising around the injury site in a condition known as Raccoon’s eye when the bruising is underneath the eye or Battle’s sign when it is behind the ears.
  • Pain at the trauma site
  • Swelling at the trauma site
  • Differential warmth at the trauma site

Other symptoms may occur which are not as severe or those which are non-specific to a skull fracture and they include:

  • Nausea
  • Vomiting
  • Headache
  • Visual disturbances
  • Restlessness
  • Irritability
  • Balance loss
  • Neck stiffness
  • Unreactive pupils
  • Confusion
  • Lightheadedness
  • Feeling drowsy

Making a diagnosis of skull fractures

This can be achieved by performing a physical examination of the head. To know the depth and severity of the damage, more invasive investigations would be required.

Different imaging modalities are beneficial such as X-rays, CT scans, MRI.

X-ray images the bone, while MRI visualizes both the bone and soft tissues thereby providing more clarity.

The CT scan or a CAT scan is the commonly used imaging modality. It produces 3D images that clearly show any skull fracture or brain damage.

Treatment of skull fractures

Skull fracture is treated after taking the patient’s age, health, medical history, type of fracture, the severity of the fracture, associated brain injuries, in consideration. It is not handled like other bone fractures.

Some types of skull fractures are not so painful and the skull will heal by itself in such circumstances.

Basal skull fracture may just require only pain-relieving drugs. In general, most people with skull fracture would only require over-the-counter medications such as acetaminophen for a short duration.

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In cases where a basal skull fracture leads to leakage of copious amounts of cerebrospinal fluid from the nose and ears, surgery may be needed. Cerebrospinal fluid is the fluid that surrounds the brain and spinal cord and serves as a cushion.

Surgery is mostly required for depressed skull fractures especially when the depression is much. This is because depressed skull fractures do not mostly heal on their own.

Apart from cosmetic issues that may be caused by depressed skull fractures, it could also lead to further brain injury if left uncorrected. Surgery is also needed here if the depression causes an excessive amount of CSF to leak or if the depression mounts pressure on the brain.

Outlook

Most cases of isolated skull fractures heal on their own, usually over 6 weeks. Surgery may be needed if there are associated injuries to other structures such as the brain.

Prevention of skull fracture

It is possible to prevent skull fractures. Using protective headgears when participating in sports such as football, during rock climbing, or when riding bicycles, can help to prevent skull fractures.

Shop for protective headgears (helmets).

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