Skull fracture: Difference between revisions
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{{Adult top}} [[skull fracture (peds)]].'' | |||
==Background== | ==Background== | ||
[[File:Cranial bones en.png|thumb|Bones of the cranium.]] | [[File:Cranial bones en.png|thumb|Bones of the cranium.]] | ||
| Line 10: | Line 9: | ||
===Depressed Skull Fracture=== | ===Depressed Skull Fracture=== | ||
*Depression or crepitus may be palpable on physical exam | *Depression or crepitus may be palpable on physical exam | ||
===Basilar Skull Fracture=== | ===[[basilar skull fracture|Basilar Skull Fracture]]=== | ||
*Raccoon eyes | *Raccoon eyes | ||
*Battle sign | *Battle sign | ||
*Hemotympanum | *Hemotympanum | ||
*Clear rhinorrhea or | *Clear [[rhinorrhea]] or otorrhea may indicate CSF leak from dural tear associated with fracture | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
[[File:PMC3088396 wjem12 1p0141f1.png|thumb|Computed tomography of a left-sided depressed skull fracture and associated subdural hematoma over the temporal region.]] | |||
*[[CT head]] | *[[CT head]] | ||
*CBC | *CBC | ||
Latest revision as of 19:49, 26 October 2021
This page is for adult patients. For pediatric patients, see: skull fracture (peds).
Background
- Presence of skull fracture significantly increases risk of underlying intracranial injury
Clinical Features
Linear Skull Fracture
- Often have scalp hematoma or tenderness to palpation
Depressed Skull Fracture
- Depression or crepitus may be palpable on physical exam
Basilar Skull Fracture
- Raccoon eyes
- Battle sign
- Hemotympanum
- Clear rhinorrhea or otorrhea may indicate CSF leak from dural tear associated with fracture
Differential Diagnosis
Head trauma
- Traumatic brain injury
- Intracranial hemorrhage
- Intra-axial
- Extra-axial
- Moderate-to-severe traumatic brain injury
- Mild traumatic brain injury
- Intracranial hemorrhage
- Orbital trauma
- Maxillofacial trauma
- Scalp laceration
- Skull fracture
- Pediatric head trauma
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
- CT head
- CBC
- Coags
- Evaluate for additional injuries
Management
Linear Skull Fracture
- If no intracranial bleed or other injuries, observe for 4-6 hrs and discharge
- Patients with advanced age, coagulopathy, or other co-morbidities may benefit from admission
Depressed Skull Fracture
- Neurosurgery consult
- Antibiotics, seizure prophylaxis (e.g. Keppra), surgery/wound debridement may be indicated in discussion with a neurosurgeon
Basilar Skull Fracture
- Neurosurgery consult
- Antibiotic prophylaxis is often started in setting of CSF leak but should be discussed with a neurosurgeon
Disposition
- Admit - except for simple linear skull fracture with no other injuries