Depressed Skull Fracture Management of 100 Cases at DHQ Teaching Hospital/Sahiwal Medical College Sahiwal

  • Dr. Muhammad Asif SLMC, Sahiwal
  • Dr. Aatika Fatima SLMC, Sahiwal


Aims: Aim is to study the presentation and management of patients with depressed skull fractures at DHQ Teaching Hospital/Sahiwal Medical College Sahiwal.

Materials and Methods: Elevation and repair of an open depressed skull fracture is often of as an emergency procedure. Common indications for emergency elevation of depressed skull fracture have been Dural tear, gross contamination, mass affect from depressed bone and/or sizable underlying extradural collection. Surgery may be performed if patient gets seizures and develops depression of skull especially frontal region which needs surgery for cosmetic reasons. Over a period of four years one hundred patients with depressed skull fractures were admitted in Neurosurgery department from July 2011 to June 2015.Mode of injury, clinical presentation, site and side of depressed skull fracture were noted. X-skull and C T scan brain was done in all cases to confirm the diagnosis and to see the underlying brain injury.

Results: Pre-operative GCS score was from 6 – 15. Focal neurological deficit was present in 16 cases. Surgical management done was wound debridement, elevation of depressed bone pieces, repair of Dura and evacuation of underlying hematoma. Fourteen patients developed different complications which were managed successfully.

Conclusion: Depressed skull fracture is a neurosurgical emergency which needs early operation to reduce the incidence of infection. Wound wash, debridement and elevation of depress fragment is treatment of choice along with Dural repair and/or evacuation of underlying hematoma as/if needed.

Author Biographies

Dr. Muhammad Asif, SLMC, Sahiwal

Department of Neurosurgery

Dr. Aatika Fatima, SLMC, Sahiwal

Department of Neurosurgery


1. Khan IU, Nadeem M. There is high incidence of skull fractures associated with extradural hamatoma in patients with head injury. Rawal Med J. 2008; 33: 228-230.
2. Kraus JF, Mac Arther DL. Epidemiologic aspects of brain injury. Neurologic Clinics, 1996; 14 (2): 435-450.
3. Graham DI and Gennareli TA. Pathology of Brain Damage after Head Injury. In: Head Injury, Cooper P and Golfinos G. 4th Ed. Morgan Hill, New York, 2000.
4. Kayanaraman S, Ramamurthi B. An analysis of 3000 cases of head injury. Paper presented at the Fifth Asian Federation Congress of the International College of Surgeons.
5. Duman H, Devici M, Uygur F et al. Reconstruction of the contour and anterior wall defects of frontal bone with a porous polyethylene implant. J Craniomaxilofac Surg, 1999; 27: 298-301.
6. Nazer H Quresh. Skull fracture Department of Neurosurgery, University of Arkansas for Medical Sciences, 2008.
7. Oehmichen M, Auer RN, Konig HG. Forensic neuropathology and associated neurology. Google books, 2009: Page 478.
8. Ersahin Y, Mutluer S, Mirzai, Palali I. Pediatric depressed skull fracture ; Analysis of 530 cases. Child Neurosyst. 1996; 12: 323-331.
9. Khan AM, Tumbull I; MacDonald S. Skull fractures. 2007: (online) Available from http//
10. Ali M, Ali L, Roghani IS.Surical management of depressed skull fracture. JPMI. 2003; 17: Record 23.
11. Al Hadad 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.
12. Rehman L, Ghani E, Hussain A, et al. Infection in compound depress fracture of the skull. J Coll Physicians Surg Pak. 2007; 17 (3): 140-143.
13. Al Derazi et al. Management strategy of depress skull fracture, Panarab J Neurosurgery, 2008; 12 (2): 80-85.
14. Cooper P R, Skull fracture and traumatic CSF fistulas. In Cooper PR (Ed). Head Injury 3rd Ed. Baltimore; Williams and Wilkins, 1993: 115-136.
15. Volmer DG, Dacey RG, Jane JA. Craniocerebral trauma. In Joynt RJ (Ed): Clinical Neurology, Vol. 3. Philadelphia; Lippincott, 1991: 1-79.
16. Usman et al. Management of depressed skull fractures: A study of 93 cases. Pakistan Journal of Neurological Surgery. Vol. 13, No 2, July – Dec., 2009.
17. Ramzan Hussain et al. Outcome of surgically managed depress skull fracture in a tertiary care hospital. Pakistan Journal of Neurological Surgery, Vol. 17, No. 2, Jul. – Dec., 2013.
18. M. Zahed Hossain et al. Depressed skull fracture; Outcome of surgical treatment. TAJ December, 2008; Vol. 21, No. 2.
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