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Pediatric depressed skull fractures: analysis of 530 cases

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Abstract

Depressed skull fractures (DSFs) account for 7–10% of children admitted to hospital with a head injury and 15–25% of children with skull fractures. We reviewed the records of 530 patients operated on for DSF from January 1, 1973, to December 31, 1993. This group was made up of 357 boys (67%) and 173 girls (33%) whose ages ranged from 1 day to 16 years (mean age 6.1 years). Fall was the most common cause of injury. Of the 530 patients with DSF, 66% had compound fractures. the incidence of compound fractures increased with age. Compound fractures caused more brain lacerations (29%) than simple fractures (15.5%) did. We also classified DSFs radiologically as true, flat, or ping-pong ball fractures. Associated intracranial lesions were found to be a bad prognostic factor. There were 13 deaths (2.5%) in this series. Satis-factory results were achieved in over 95% of the patients. Compound fractures are associated with a worse outcome and a higher incidence of intracranial lesions and cortical laceration. Unilateral pupillary dilatation and an admission GCS score of 8 or less are ominous signs in regard to mortality. We also found that the deeper the depressed bone, the higher the risk of both dural tear and cortical laceration and the worse the prognosis. A conservative approach should be followed in cases of simple DSF without associated intracranial hematoma and in cases in which the bone depression is not deeper than 1 cm.

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References

  1. Blankenship JB, Chadduck WM, Boop FA (1990/91) Repair of compound depressed skull fractures in children with replacement of bone fragments. Pediatr Neurosurg 16:297–300

    Google Scholar 

  2. Braakman R (1972) Depressed skull fracture: data, treatment, and follow-up in 225 consecutive cases. J Neurol Neurosurg Psychiatry 35:395–402

    Google Scholar 

  3. Choux M (1986) Incidence, diagnosis, and management of skull fractures. In: Raimondi AJ, Choux M, Di Rocco C (eds) Head injuries in the newborn and infant. Springer, New York Berlin Heidelberg, pp 163–182

    Google Scholar 

  4. Coulon RA Jr (1983) Depressed skull fractures in children. Concepts Pediatr Neurosurg 4:253–263

    Google Scholar 

  5. Hahn YS, Fuchs S, Flannary AM, Barthel MJ, McLone (1988) Factors influencing posttraumatic seizures in children. Neurosurgery 22:864–867

    Google Scholar 

  6. Harwood-Nash DC, Hendrick EB, Hudson AR (1971) The significance of skull fracture in children. A study of 1187 patients. Radiology 101:151–156

    Google Scholar 

  7. Jennett B, Miller JD (1972) Infection after depressed fracture of the skull. Implications for management of nonmissile injuries. J Neurosurg 36:333–339

    Google Scholar 

  8. Jennett B, Miller JD, Braakman R (1974) Epilepsy after nonmissile depressed skull fracture. J Neurosurg 41:208–216

    Google Scholar 

  9. Matson DD (1969) Neurosurgery of infancy and childhood, 2nd edn. Thomas, Springfield

    Google Scholar 

  10. Miller JD, Jennett WB (1968) Complications of depressed skull fracture. Lancet 2:991–995

    Google Scholar 

  11. Oh S (1983) Clinical and experimental morphological study of depressed skull fracture. Acta Neurochir (Wien) 68:111–121

    Google Scholar 

  12. Raimondi AJ, Hirschauer J (1984) Head injury in the infant and toddlercoma scoring and outcome scale. Child's Brain 11:12–35

    Google Scholar 

  13. Steinbok P, Flodmark O, Martents D, Germann ET (1987) Management of simple depressed fractures in children. J Neurosurg 66:506–510

    Google Scholar 

  14. Van Den Heever CM, Van Der Merwe DJ (1989) Management of depressed skull fractures. J Neurosurg 71:186–190

    Google Scholar 

  15. Zbinden B, Kaiser G (1989) Specific aspects of depressed skull fractures in childhood. Z Kinderchir 44:3–7

    Google Scholar 

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Ersahin, Y., Mutluer, S., Mirzai, H. et al. Pediatric depressed skull fractures: analysis of 530 cases. Child's Nerv Syst 12, 323–331 (1996). https://doi.org/10.1007/BF00301021

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  • DOI: https://doi.org/10.1007/BF00301021

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