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.]] | |||
*Presence of skull fracture significantly increases risk of underlying intracranial injury | *Presence of skull fracture significantly increases risk of underlying intracranial injury | ||
==Clinical Features== | ==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|Basilar Skull Fracture]]=== | |||
*Raccoon eyes | |||
*Battle sign | |||
*Hemotympanum | |||
*Clear [[rhinorrhea]] or otorrhea may indicate CSF leak from dural tear associated with fracture | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*CT head | [[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]] | |||
*CBC | *CBC | ||
*Coags | *Coags | ||
*Evaluate for additional injuries | |||
==Management== | ==Management== | ||
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===Depressed Skull Fracture=== | ===Depressed Skull Fracture=== | ||
*Neurosurgery consult | *Neurosurgery consult | ||
*Antibiotics, seizure prophylaxis, surgery/wound debridement may be indicated in discussion with a neurosurgeon | *[[Antibiotics]], seizure prophylaxis (e.g. [[Keppra]]), surgery/wound debridement may be indicated in discussion with a neurosurgeon | ||
===Basilar Skull Fracture=== | ===Basilar Skull Fracture=== | ||
*Neurosurgery consult | *Neurosurgery consult | ||
*Antibiotic prophylaxis is often started in setting of CSF leak but should be discussed with a neurosurgeon | *[[Antibiotic]] prophylaxis is often started in setting of CSF leak but should be discussed with a neurosurgeon | ||
==Disposition== | ==Disposition== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Trauma]][[Category:Orthopedics]][[Category:Neurology]] | |||
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