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A skull fracture is a break in the bone of the skull. For most skull fractures, treatment consists of close observation in the hospital and medication to relieve pain during the healing process. However, some skull fractures require surgery.
There are four major types of skull fracture:
Linear skull fracture
This is the most common type of skull fracture. In a linear fracture, there is a break in the bone, but the bone does not move. Patients with these fractures may be observed in the hospital for a brief amount of time and can usually resume normal activities in a few days. Usually, no interventions are necessary.
Depressed skull fracture
This type of fracture may be seen with or without a cut in the scalp. In this fracture, part of the skull is sunken from the trauma and may require surgical intervention, depending on the severity, to help correct the depression.
Diastatic skull fracture
This is a fracture that occurs along one of the suture lines in the skull. In this type of fracture, the normal suture lines widen. Such fractures are most often seen in infants.
Basilar skull fracture
This is the most serious type of skull fracture and involves a break in the bone at the base of the skull. Patients with this type of fracture frequently have bruises around their eyes and behind their ears. They may also have clear fluid draining from their noses or ears. This fluid, called cerebrospinal fluid (CSF), is normally held closely around the brain within the dura mater. CSF may leak if the dura mater is torn. Patients with basilar skull fractures usually require close observation in the hospital.
Also, a skull fracture can be referred to as either compound or closed. In a compound fracture, bone exits and is visible through the skin, or a deep wound exposes the bone through the skin. In a closed fracture, bone is broken, but the skin is intact.
A compound fracture is considered an emergency. Seek immediate medical attention for this type of fracture.
Other terms used to describe a skull fracture are:
- Greenstick: The break is an incomplete fracture and the broken bone is not completely separated.
- Comminuted: The break is in three or more pieces.
The following are the most common symptoms of a skull fracture. However, each person may experience symptoms differently.
- Pain in the injured area
- Swelling in the injured area
- Obvious depression or abnormality in the injured area
- Warmth, bruising, or redness in the injured area
- Blood or clear fluid draining from the ears or nose
- Bruising behind the ears or around the eyes
- Facial weakness
A diagnosis relies on physical examination and imaging studies of the head. During the examination, the physician obtains a complete medical history of the patient and asks how the injury occurred.
Imaging studies may include X-ray, magnetic resonance imaging (MRI) or computed tomography (CT) scan of the head. The preferred diagnostic imaging test is CT scan because it can show highly detailed images of the bone, tissue, and other structures in the head. Also, these imaging studies are used to check for possible injury to the brain.
Fractures occur when there is more force applied to the bone than the bone can absorb. Skull fractures can occur from falls, sports, motor vehicle accidents, or direct blows to the head or body.
Children and adults can sustain skull fractures, but there are important differences between the bones of children compared with those of adults.
- A child’s bone heals much faster than an adult’s bone. The younger the child, the faster the healing occurs.
- Bones are softer among children than adults and tend to buckle or bend rather than completely break.
At Columbia, our neurosurgeons use the latest surgical treatments to treat skull fractures, providing the best possible outcomes.
Specific treatment for a fracture will be determined by the neurosurgeon, taking into account several factors, including:
- The patient’s age, overall health, and medical history
- Severity of the fracture
- Type of fracture
The goal of skull fracture treatment is to control pain, promote healing, and prevent complications. For most skull fractures, which are linear fractures, surgical intervention is not needed. Instead, physicians prescribe medication to control pain and maintain close observation in the hospital.
Surgery may be needed to repair compound fractures, comminuted fractures and some types of closed fractures, and also to stitch up any tears in the dura mater and scalp.
Proper diagnosis is crucial to distinguish between skull fractures that need and do not need surgical treatment—and thus to avoid potential complications.