Depressed Skull

Fracture
By Muhammad Yusuf
 Depressed Skull Fracture
• Depressed skull fracture was common
below in the age group of 16–45 years.
• There was a predominance of male
cases over females with a ratio of 5:1.
• Traffic injury and alleged assault was the
most common of depressed skull
fracture.
• Can be associated with intracranial
lesion, which the most common was
contusion.
 Depressed Skull Fracture
• Depressed skull fractures result from a high-energy direct blow to small surface area
of the skull with the blunt object.
• Comminution of fragments starts from the point maximum impact and spreads
centrifugally.
• Most of the depressed fractures are over the frontoparietal region because the
bone is thin.
• The brain can be affected directly by damage to the nervous system and bleeding.
• The brain can also be affected indirectly by blood clots that form under the skull
and then compress the underlying brain tissue.
 Evaluation
• Skull X-Ray
• CT-Scan
 Treatment
• Prophylactic antibiotics
• Anticonvultants
• Surgical management
 Indication for Surgery
• 1. open (compound) fractures
• (A) surgery for fractures depresses>thickness of calvaria and those not meeting criteria for non-surgical management listed
below
• (B) Non surgical management may be considered if:
• There is no evidence (clinical or CT) of dural penetration (CSF leak, intradural, pneumocephalus on CT)
• And no significant intracranial hematoma
• And depression in <1cm
• And no wound infection or gross contamination
• And no gross cosmetic deformity

• 2. closed (simple) depressed fractures may be managed surgically or non surgically

 Surgical Methods
• 1. elevation and debridement are recommended
• 2. option: if there is no evidence of wound infection, primary bone
replacement
• 3. antibiotics should be used for all compound depressed fractures
 Technical consideration of surgery
• Surgical goals
• 1. debridement of skin edges
• 2. elevation of bone fragments
• 3. repair of dural laceration
• 4. debridement of devitalized brain
• 5. reconstruction of the skull
• 6. skin closure
 Complications
• Wound infection
• Meningitis
• CSF leak
• Focal neurological deficits
• Pseudomeningocele

• Other complications
• Late epilepsy (up to 15%)
• Mortality rate (1.4-19%)
THANK YOU