Depressed skull fractures

A depressed skull fracture with the outer table of the skull lying at or below the level of the inner table is considered significant. These fractures are divided into closed (or simple) and open (or complex). They may tear the dura and lacerate the underlying brain, and subdural, epidural, or intracerebral hematomas may develop. An open fracture raises the concern that contaminated material may enter the cranial cavity.

H4>Closed depressed fractures

Traditionally, elevation of a depressed skull fracture was performed to help improve focal neurological deficits. However, it appears that the cortical damage causing these deficits occurs at the time of impact and is not due to the subsequent pressure of the depressed fragments; therefore elevation of depressed fragments would not be expected to improve neurological recovery. Studies bear this out, as no difference can be shown between patients treated surgically and non-surgically (Jennett e.L al 1974).

Post-traumatic epilepsy occurs after depressed skull fracture in 9.5 per cent of cases. However, the incidence of late epilepsy in patients with depressed skull fractures with no intracranial blood is not changed by elevating the fragment ( Jennett ef a/ 1974). Therefore the only firm indication for elevating a closed depressed skull fracture is correction of a cosmetic deformity.

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