Calvarial fractures in children are generally linear, although compound and 'ping-pong' (rounded, indented) fractures are also seen. Diastatic fractures, consisting of traumatic separation of cranial bones at the sutures, are more common in children than adults. In infants and young children with growing skulls, many fractures will adequately remodel without intervention. Indications for the surgical treatment of depressed fractures include:
1. Cosmetic deficit (depression visible on forehead).
2. Depressed skull fracture (outer table on one side of fracture line is indented past the inner table on the other) with compression of underlying brain parenchyma (particularly if there is an associated neurological deficit).
3. Open depressed skull fracture (scalp laceration over skull fracture), particularly if intradural pneumocephalus or CSF leak through skin suggests the presence of a dural tear and thus risk for intradural infection.
4. Underlying extra-axial or intracerebral hematoma that requires evacuation.
There is little evidence that the elevation of depressed skull fractures reduces the incidence of chronic seizure disorder. Children less than 1 year of age are at risk for growing skull fractures, sometimes referred to as leptomeningeal cysts. All small
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