Pattern of Skull Fractures and Its Outcome in Pediatric Head Injury Patients

Keywords: Head Injury, Skull fracture, Glasgow coma score, Traumatic brain injury, Glasgow outcome scale.

Abstract

Objective: Skull fractures are common in pediatric age group. The surgical management of paediatric patients with a skull fracture differs among institutions and surgeons. Our object of this study was to assess the pattern of skull fractures and outcome in paediatric population.

Material and Methods: This study was conducted in the department of neurosurgery of a tertiary care hospital from June 2018 to April 2020. We included 152 children between ages 5 to 11 years who were brought with the head trauma and diagnosed to have skull fracture on computerized tomography (CT) Scan brain.

Results: The mean age of patients was 6.91 + 1.84 years. There were 59.8% males and 40.1% females. The most common type of fracture at presentation was depressed fracture in 42% patients, followed by linear (35%) and compound fractures (23%). Parietal fractures were the commonest (63.1%) in our study. Associated intracranial hematomas were seen in 37.5% patients, epidural hematoma being the most common. Surgically treated patients were 36%. Good recovery was seen in 73% patients while mortality was 10.5%.

Conclusion: Isolated skull fractures are overall benign conditions. Linear parietal skull fractures have good outcome amongst all fracture types.

Author Biographies

Ghulam Muhammad, Jinnah Postgraduate Medical Centre, Karachi.

Consultant Neurosurgeon

 

Farrukh Javeed, Jinnah Postgraduate Medical Centre Karachi.

Consultant Neurosurgeon

Lal Rehman, Jinnah Postgraduate Medical Centre, Karachi.

Professor and Head of Department

Neurosurgery

Asad Abbas, Jinnah Postgraduate Medical Centre, Karachi.

Consultant Neurosurgeon

Ali Afzal, Jinnah Postgraduate Medical Centre, Karachi.

Consultant Neurosurgeon

References

1. Lloyd DA, Carty H, Patterson M, Butcher CK, Roe D. Predictive value of skull radiography for intracranial injury in children with blunt head injury. Lancet. 1997;349:821–4
2. Mossop D, Soysa S. The use of skull X-rays in head injury in the emergency department - A changing practice. Ann R Coll Surg Engl. 2005;87:188–90.
3. Palchak MJ, Holmes JF, Vance CW, Gelber RE, Schauer BA, Harrison MJ, et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med. 2003;42:492–506.
4. Powell EC, Atabaki SM, Wootton-Gorges S, Wisner D, Mahajan P, Glass T, Miskin M, Stanley RM, Jacobs E, Dayan PS, Holmes JF, Kuppermann N. Isolated linear skull fractures in children with blunt head trauma. Pediatrics. 2015 Apr;135(4):e851-7. doi: 10.1542/peds.2014-2858.
5. Metzger RR, Smith J, Wells M, Eldridge L, Holsti M, Scaife ER, et al. Impact of newly adopted guidelines for management of children with isolated skull fracture. J Pediatr Surg. 2014;49;1856–60.
6. Culotta PA, Crowe JE, Tran QA, Jones JY, Mehollin-Ray AR, Tran HB, et al. Performance of computed tomography of the head to evaluate for skull fractures in infants with suspected non-accidental trauma. Pediatr Radiol. 2017;47(1):74-81
7. Arneitz C, Sinzig M, Fasching G. Diagnostic and Clinical Management of Skull Fractures in Children. J Clin Imaging Sci. 2016;16(6):47. doi: 10.4103/2156-7514.194261.
8. Perheentupa U, Kinnunen I, Grénman R, Aitasalo K, Mäkitie AA. Management and outcome of pediatric skull base fractures. Int J Pediatr Otorhinolaryngol. 2010;74(11):1245-50.
9. Tunik MG, Powell EC, Mahajan P, Schunk JE, Jacobs E, Miskin M, et al. Clinical presentations and outcomes of children with basilar skull fractures after blunt head trauma. Ann Emerg Med. 2016;68(4):431-40.
10. Vezina N, Al-Halabi B, Shash H, Dudley RR, Gilardino MS. A Review of Techniques Used in the Management of Growing Skull Fractures. J Craniofac Sur. 2017;28(3):604-9.
11. Zulfiqar M, Kim S, Lai JP, Zhou Y. The role of computed tomography in following up pediatric skull fractures. Am J Surg. 2016;16:7:20
12. Hassan SF, Cohn SM, Admire J, Nunez-Cantu O, Arar Y, Myers JG, et al. Natural history and clinical implications of nondepressed skull fracture in young children. J Trauma Acute Care Surg. 2014;77(1):166-9
13. Bonfield CM, Naran S, Adetayo OA, Pollack IF, Losee JE. Pediatric skull fractures: the need for surgical intervention, characteristics, complications, and outcomes. J Neurosurg Pediatr. 2014;14(2):205-11. doi: 10.3171/2014.5.PEDS13414.
14. Al-Haddad SA, Kirollos R. A 5-year study of the outcome of surgically treated depressed skull fractures. Ann R Coll Surg Engl. 2002;84(3):196-200.
15. Steinbok P, Flodmark O, Martens D, Germann ET. Management of simple depressed skull fractures in children. J Neurosurg. 1987;66(4):506-10. doi: 10.3171/jns.1987.66.4.0506.
16. Reid SR, Liu M, Ortega HW. Nondepressed linear skull fractures in children younger than 2 years: Is computed tomography always necessary? Clin Pediatr (Phila) 2012;51:745‑9.
17. Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr., Atabaki SM, Holubkov R, et al. Identification of children at very low risk of clinically‑important brain injuries after head trauma: A prospective cohort study. Lancet 2009;374:1160‑70.
Published
2021-01-01
Section
Original Article