With the normal forces of labor, skull fractures may develop from pressure of the skull on the ischeal tuberosity. This type of fracture is usually located around the prominent portion of the parietal bone. Linear fractures are frequently depressed
below the level of the calvarium. Typically described as a "ping pong" fracture, the inner cortical surface is expanded and fractured, while the outer table is pushed inwards. Skull fractures and associated deformities can also occur from the use of forceps during delivery.
Surgical indications for elevation of a depressed skull fracture include an intrac-ranial hematoma necessitating evacuation, cosmetic reconstruction, or the presence of an underlying parenchymal injury (although this may not be necessary if the injury is minor). Early elevation is often straightforward, requiring simple outward pressure exerted by an instrument inserted through a small burr hole placed at the perimeter of the depressed fragment. Rarely, a craniotomy is required.
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