Pediatric Basilar Skull Fractures

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December 28, 2012
Edward Smith

Two studies were done to look at various aspects of basilar skull fractures in children. These are fractures through the inferior part of the brain that are associated with raccoon’s eyes and battle signs, which are areas of bruising around the eyes and behind the ears, respectively. Basilar skull fractures can be seen on CT scan of the brain and skull and often do not include any kind of intracranial injuries. The first study was a retrospective review of charts of patients that were discharged from the emergency room or from the hospital with a diagnosis of basilar skull fracture. Each patient had a clinical sign or x-ray evidence of a basilar skull fracture. There was a subgroup of patients with a normal neurological signs and a Glasgow coma score of 15 that had simple basilar skull fractures.
There were 239 patients in the study. A hundred and fourteen patients or 48 percent had simple basilar skull fractures. This group of simple fractures had vomiting at a rate of 6 percent and a meningitis rate of 1 percent. There were no cases of intracranial hemorrhages and no patients with simple basilar skull fractures needed any kind of surgery. The researchers concluded that some patients with simple skull fractures (basilar) may not need to be hospitalized.
The management of pediatric skull fractures can be challenging for doctors who treat these types of fractures. The second study looked at the management of patients with skull fractures by a multidisciplinary team of doctors at a major tertiary care center. Like the first study, this was a retrospective study.
The study covered 13.5 years from 1996 through 2009. They found 63 patients aged 1-18 years with a mean age of 10.7 years. Traffic accidents were the main cause of these fractures at 38 percent. The most common type of skull fracture was a basilar skull fracture through the temporal bone at 64 percent. The second most common type of fracture was a longitudinal fracture through the temporal bone at 45 percent. Transverse temporal bone fractures accounted for 23 percent. Ten cases had comminuted or mixed type of fracture (25 percent).

The second most type of basilar skull fracture was through the spheno-ethmoid complex at 41 percent followed by a fracture extending through the orbital bone at 35 percent. A total of 43 percent of patients had of fractures also had some kind of brain injury. Defects in the neurological system were found early in 21 patients or 33 percent. Ten patients or 16 percent suffered from permanent neurological changes. One patient died after a week of intensive therapy. A total of 86 percent of patients were discharged to home with minimal neurologic defects while 8 patients or 13 percent of them needed further rehabilitation after their hospitalization. The Glasgow coma scale predicted moderate to poor outcome if it was 8 or less at any time.

The researchers concluded by saying that, while basilar skull fractures are rare in kids and mortality is rarer still but intracranial trauma does occur with these types of patients. Early neurological deficits were found in patients with intracranial injury in about a third of patients. Less than one-sixth of patients suffered from any kind of permanent psychological or neurological injuries.