Skull fracture: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
*CT head | *[[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]] | |||
Revision as of 17:53, 17 August 2019
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 ottorhea 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