Skull fracture (peds)

SKULL FRACTURES

- fxs are predictors of intracranial inj

- fx can lead to complications

- infants higher risk for fx since

o thinner bones- fx parietal first, then occ, frontal, temp

o linear fx most common- then depressed and basilar

- most fxs have hematomas

- larger hematoma more likely to have fx

- basilar skull fx usually have hemotympanum, battle sign, csf leak, CN palsy

- 30% of linear skull fx have intracranial inj but 40- 100% of intracranial inj assoc with fx

- linear fx heal without complication except growing skull fx

- growing skull fx- enlarge overtime producing cranial defect- from tear in dura. CSF pulsation or meninges herniation and bone remodeling. Usually >3mm separation and present 18 mo after initial injury. Most need surg

- depressed skull fx- complications include intracranial hem, dural laceration, sz, focal neuro,

- basilar skull fx- bleed into middle ear, mastoid air cells, csf leak and meningitis,, hearing loss, CN 6-7-8 defect- transient or permanent

- no prophylactic abx- leaks usually stop in 1 wk

- plain xrays better than ct to dx skull fx but still need ct to eval brain