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Depressed skull fracture

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What is a depressed skull fracture?

Fractures in which the bone fragments are displaced below the skull, called a depressed. Such fractures result in compression of the brain.

There are two types of fractures:

  • impressionis when bone fragments are linked to whole sections;
  • depression, when the damaged bone break off and lose the connection with the cranial surface.

Fractures can occur in two cases:

  • When applied to a stationary head is hit with a shock surface is smaller than the cranial vault.
  • In the fall of a person onto an object with a small surface.

What happens during a depressed fracture of the skull?

Options of many fractures, this is due to the ratio of the areas of the impact surface and the skull vault, moving at this moment the head, the shape of the wounding object, elasticity of bones, the presence of headgear.

Common types of damage:

  • Small striking surface, moving with great speed, leaving impressionnee fractures, the scalp can be damaged. How added to the bone the Dura mater depends on whether the fracture penetrating.
  • When hitting a narrow object on a stationary head, brain damage is limited to the epicenter of the strike.
  • Hitting the head when falling from a height is accompanied by an extension of a linear fracture.
  • Special kind impressions is the split of the cranial plates, when the inner plate forms a depressed fracture. This fracture occurs when the impact surface of a blunt.
  • Upon impact with the force of a large object fragments are pressed into the cavity of the skull. Brain damage occurs at the epicenter of impact.
  • Kind of a depressed fracture depends on the type and location of impact. The most vulnerable thinned bone surface. Here the deep impression has minimal manifestation.
  • Depressed fracture of the skull base is rare but when it occurs, is formed, as a rule, a penetrating fracture.

At a young age fractures often impressionnee, meninges damaged rarely. In infants impression of the skull bones occurs without the formation of fracture. This is due to the elasticity of the skull bones. In old age, frequent fractures with the formation of many fragments, bearing the cross-cutting nature.


Symptoms of depressed skull fractures

The impression of the skull is characterized by the appearance of symptoms on the part of virtually all systems.

Neurological symptoms depending on the locations of the depressions. Injury severity is determined by the magnitude of compression of the brain. The symptoms are vague, the cramps come only with the defeat of the frontal lobes. Symptoms of hair loss is present mainly when hemorrhage.

When a depressed fracture is observed the compression of the large blood vessels, leading to epidural hematoma. Paresis is observed in the foot or in the hand, a violation of the outflow of CSF, leading to hydrocephalus. Occur hypertensive nature pain, dizziness, reduced hearing and vision.

Somatic disorders: shock, hypotension, fat embolism.


Possible complications and their prevention

  • The scar soft tissue. Prevention includes the use of a sharp scalpel, treatment and rehabilitation of wounds.

  • The processes of suppurationleading to abscess of the brain. Prevention is to release the bones from foreign bodies and blood clots.

  • Brain scar, wound liquorrhea can cause an attack of epilepsy. Prevention comes to the treatment of the wound, if necessary use a prosthetic membrane.


Diagnosis

If the victim discovered a gaping wound, a fracture is diagnosed without difficulty. Closed head injury diagnosis is difficult and with deep impressions. Palpation is invalid, otherwise the fragments can be displaced.

Best method is x-ray diagnostics, giving an idea of the nature of the wounds. MRI is a modern diagnostic method that allows to determine the state of the brain as a whole. Comprehensive information gives spiral CT, which determines the wound surface and possible threats.

Treatment of depressed fractures of the skull

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Before admission, it is important to stop the bleeding by putting a pressure bandage so as not to displace the fragments. Depressed fracture treated surgically. Contraindications to the intervention – shock, fat embolism, profuse blood loss. Conservative treatment is possible in a closed fracture, if there is no compression of the meninges.

The basic principles adhered to in the treatment of:

  • Mobilization of fragments of spherical milling cutter of small diameter, keeping the area intact bone.
  • Loose bone fragments were fixed external bony plate, extracted after susiana plate.
  • Multisplintered depressions operate using a wide craniotomy was performed. This allows you to quickly stop the bleeding.
  • If it is impossible to conduct a CT dissection of the meninges to study the state of brain space. Method not allowed if the wound is contaminated.
  • If the Dura is damaged, conduct an audit of brain space. A prosthetic sheath is a membrane made of polytetrafluoroethylene with a thickness of 3 mm.
  • The most difficult is the turning point, when sharp fragments intrude into the cavity of the skull, damaging large vessels. There is a need to access megalochary slit, closure of the hard shell and the introduction of strips of muscle, which can be replaced with plate "Tachocomb".
  • In any type of depressed fracture the final stage is the restoration of the surface of the skull. Optimum plastic preserved fragment, combining it with a common cover to bonding. Strengthening the bones is performed with titanium plates. If the bone fragments are extracted, the further work with them is possible after a thorough disinfection.

  • At small tlacah, lost contact with the periosteum, the contamination of the wound or swelling of the brain reconstruction of dangerous. In this case, applied a prosthetic Dura mater, providing sealing of the wound.

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Forecast

Often when depressed fractures, even broader, common symptoms mild. The main thing in the treatment is to restore blood flow and the integrity of the membranes and the integuments. Then recovery takes place almost completely. When festering wounds after the operation, the predictions deteriorate.

Disability 3 degree set of people who have left the bone defect with a size of at least 3x3, not enclosed in bone.

When a depressed fracture of the skull should immediately consult a neurosurgeon.