Clinicoradiological Features and Early Postoperative Outcome of Depressed Skull Fractures
Keywords:
Depressed skull fracture, surgical outcome, clinicoradiological featuresAbstract
Introduction: Skull fractures are frequently associated with head injury, especially in younger children and young adults. Upto 12% of head injury cases are associated with depressed fracture with a variety of clinical and radiological features. Clinical and radiological features of intracranial injuries are the chief determinants of postoperative functional outcome.
Objectives: We aimed to study the diverse nature of clinical and radiological features and to determine their impact on the postoperative outcome in patients of depressed skull fractures.
Materials and Methods: This is a prospectively conducted case series of a descriptive nature, conducted at the department of Neurosurgery, Hayatabad Medical Complex Peshawar between January 2015 and December 2015. All patients between age 15 years and 65 years, from both genders with the diagnosis of depressed skull fractures due to closed head injury were included. Patients with penetrating nature of trauma such as gunshot wounds or stab wounds were excluded.
Results: 65 patients with 46 (70.9%) males and 19 (29.2%) females in a ratio of 2.42:1. The most common cause of injury was road traffic accident with a mean age of 25.14 years ± 6.23 SD. Compound fractures were present in 56.9% while the rest were simple. Mean arrival GCS was 11.0 ± 2.29 SD. Mean GCS at discharge was 12.8 ± 3.28 SD and mean GOS was 4.05 ± 1.13 SD. Favourable outcome was recorded in 75.4% of patients while the rest were in unfavourable group. Most common complications were septic which occurred in a total of 15.4% patients and was followed in frequency by CSF leaks postoperatively. There was no mortality.
Conclusions: The clinical features such as arrival GCS, pupillary abnormalities, focal deficits and radiological features such as the presence of intracranial and parenchymal lesions predict the outcome in terms of Glasgow outcome score. Most commonly septic complications and CSF leaks occur as complications after surgery.
References
2. Hossain MZ, Mondle M, Hoque MM. Depressed skull fracture: outcome of surgical treatment. J Teacher Assoc. 2008; 21 (2): 140-6.
3. Ohaegbulam SC, Mezue WC, Ndubuisi CA, Erechu-kwu UA, Ani CO. Cranial computed tomography scan findings in head trauma patients in Enugu, Nigeria. Surg Neurol Int. 2011; 2.
4. Provenzale JM. Imaging of traumatic brain injury: a review of the recent medical literature. Am J Roentge-nol. 2010; 194 (1): 16-9.
5. Mushtaq, Azam F, urRehman R, Khattak A, Alam W, Anayatullah. Surgical management and outcome of depressed skull fracture. Pak J Neurol Surg. 2010; 14 (1): 30-4.
6. Shokouhi G, Sattarnezhad N, Motlagh PS, Mahdkhah A. Correlation of Fracture Depression Level and Dural Tear in Patients With Depressed Skull Fracture. Neuro-surg Quart. 2014; 24 (1): 84-6.
7. Wang W-h, Lin J-m, Luo F, Hu L-s, Li J, Huang W. Early diagnosis and management of cerebral venous flow obstruction secondary to transsinus fracture after traumatic brain injury. J Clin Neurol. 2013; 9 (4): 259-68.
8. Syed AA, Arshad A, Abida K, Minakshi S. Paraperesis: a rare complication after depressed skull fracture. Pan Afr Med J. 2012; 12: 106.
9. Nnadi MO, Bankole OB, Arigbabu SO. Outcome of surgically treated non-missile traumatic depressed skull fracture. Niger Postgrad Med J. 2014; 21 (4): 311-4.10. Matsui T, Kihira M, Kobayashi H. [Experimental stu-dies of skull fracture in the temporal region (author's transl)]. No Shinkei Geka. 1975; 3 (2): 123-9.
11. Burns EC, Grool AM, Klassen TP, Correll R, Jarvis A, Joubert G, et al. Scalp hematoma characteristics associ-ated with intracranial injury in pediatric minor head injury. Acad Emerg Med. 2016.
12. Rehman L, Ghani E, Hussain A, Shah A, Noman MA, Khaleeq Uz Z. Infection in compound depressed frac-ture of the skull. J Coll Physicians Surg Pak. 2007; 17 (3): 140-3.
13. Ali Nawaz K, Sumaira M, Ian T, Riyadh A-O, Bernard D C, C Douglas P, et al. Imaging in skull fractures, 2015 March 25, 2016. Available from:
http://emedicine.medscape.com/article/343764-overview.
14. Nazer H Q, Griffith HI, Brian H K, Francisco T, Michael G N. Skull fractures, 2015. Available from:
http://emedicine.medscape.com/article/248108-overview.
15. Al-Haddad SA, Kirollos R. A 5-year study of the out-come of surgically treated depressed skull fractures. Ann R Coll Surg Engl. 2002; 84 (3): 196-200.
16. Ersahin Y, Mutluer S, Mirzai H, Palali I. Pediatric dep-ressed skull fractures: analysis of 530 cases. Child Nerv
Sys. 12 (6): 323-31.
17. Lee TT, Aldana PR, Kirton OC, Green BA. Follow-up computerized tomography (CT) scans in moderate and severe head injuries: correlation with Glasgow Coma Scores (GCS), and complication rate. Acta Neurochir (Wien), 1997; 139 (11): 1042-7; Discussion 7-8.
18. Ebtehaj M, Yaqubi S, Seddighi AS, Seddighi A, Yazdi Z. Correlation between BIS and GCS in patients suffer-ing from head injury. Ir J Med Sci. 2012; 181 (1): 77-80.
19. Ali M, Ali L, IS R. Surgical management of depressed skull fracture. J Postgrad Med Inst. 2001; 17 (1): 116-23.
20. Wylen EL, Willis BK, Nanda A. Infection rate with re-placement of bone fragment in compound depressed skull fractures. Surg Neurol. 1999; 51 (4): 452-7.
21. Nadell J, Kline DG. Primary reconstruction of depres-sed frontal skull fractures including those involving the sinus, orbit, and cribriform plate. J Neurosurg. 1974; 41 (2): 200-7.
22. van den Heever CM, DJ. vdM. Management of depres-sed skull fractures. Selective conservative management of nonmissile injuries. J Neurosurg Nurs. 1989; 71 (2): 186-90.
Downloads
Published
Issue
Section
License
The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).
