Traumatic Skull Fractures

Skull fractures generally go along with head or brain injuries. While the skull is generally a tough bony structure that provides great protection for the brain inside, a blow to the skull from a blunt or penetrating trauma to the skull can cause a fracture and increased damage to the brain. When the brain is damaged, the actual brain tissue can become damaged and there can be bleeding around the brain. Blood clots can form beneath a fractured skull in the form of a subdural hematoma or an epidural hematoma.

Fractures of the skull can be simple, which means there is a slight break in the bone with nothing visible on the outside. A linear skull fracture involves a long thin line that does not splinter nor does it depress or distort the bone. A depressed skull fracture havens when part of the fractured bone sinks into the cerebral space. A compound fracture involves loss of skin or a break in the skin along with splintering of the bone.

Most people get skull fractures from motor vehicle accidents but some can get a fracture from a fall from a high place, a physical assault or a sports injury. Penetrating trauma can result in a skull fracture but usually results in a simple hole in the bone. The main symptoms of a skull fracture include bleeding around the eyes or from the ears or nose, bruising under the eyes or behind the ears, confusion, change in pupil size, seizures, cerebrospinal fluid from the ears or from the nose, fatigue, headache, slurred speech, nausea, loss of consciousness, stiff neck, irritability, visual disturbances, and vomiting. Bruising can take up to a day or two to develop.

If you come across a person with a possible skull fracture, remember your ABCs of resuscitation and do CPR if necessary. Do not move the victim unless they are in danger and make sure you stabilize the head and neck with a cervical collar until the neck is cleared by x-ray. If there is an open injury, do not probe it but cover it with a sterile gauze or cloth. This is especially true if the wound is bleeding. If the victim is vomiting, keep the stability of the head and neck and turn the entire victim to one side in order to vomit. If the victim is experiencing any of the symptoms noted above, they should be transported to the nearest emergency facility.

Don’t move the victim unless it is necessary for their safety, in part because they may have a concomitant spinal injury, and don’t remove any objects that may be protruding. Don’t let the victim continue any physical activity following the injury to the head. Don’t give the victim any medicines by mouth or IV until a physician is consulted. Never leave the victim alone following this type of injury.

Injuries to the skull require a multidisciplinary approach. The victim must see a trauma surgeon for evaluation of the total injury package. A maxillofacial surgeon is necessary for facial fractures. A neurosurgeon may be necessary to handle whatever issues come up related to the skull fracture. Often skull fractures, especially those at the base of the skull, are overlooked because of more severe trauma. While there is a natural order of treating these injuries, skull fractures must take a high priority.

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