What is a skull fracture?
A skull fracture consists mainly of the breakage of one or more bones of the head. In fact, a skull fracture not only causes the fracture in the bone, but also results in injury to veins and arteries, which may bleed close to the brain tissue. Damage to nerves and brain tissue also occurs.
Skull fractures may or may not involve brain injury, although the fracture usually does not involve brain injury. Fractures, especially those at the back and base of the skull, can tear the meninges, the tissues that protect the brain.
There are different types of skull fractures:
- Linear: occurs in definite lines. It is usually a closed fracture that has no depressions or pulverizations and does not cut the skin.
- Compound: includes splinters in the bone and exits through the skin. In this case a skull fracture occurs, usually associated with brain damage.
- With collapse: in this case the skull collapses, putting pressure on the brain.
- Basal: the fracture is at the base of the skull and is usually located around the eyes, nose or cranial base near the spine.
Prognosis of the disease
The prognosis of the disease will be positive as long as there is no brain damage. Fractures in the skull are usually mild, and the necessary treatment is minimal, consisting simply of resolving wound problems and assessing the patient’s neurological status. However, if brain damage is present, the consequences can be very severe, ranging from disabilities – which may or may not be permanent – to death.
Symptoms of skull fracture
Symptoms of skull fracture may include the following:
- Bleeding, which may be either from the wound or from the nose, ears or around the eyes.
- Appearance of bruising under the eyes or ears
- Change in pupil size
- Confusion
- Seizures
- Balance problems
- Drowsiness
- Migraine and headache
- Loss of consciousness
- Exceptionally stiff neck
- Speech and pronunciation problems
- Nausea and vomiting
- Motor difficulties
- Visual disturbances
Picture of a perforation in the skull
Medical tests for skull fracture
Skull fractures are usually diagnosed by computed tomography (CT). In this case, this test is better than magnetic resonance imaging (MRI).
What are the causes of a skull fracture?
The causes of head injuries, and therefore injuries involving a skull fracture, are usually injuries that originate from impacts, blows or shocks to the head. They occur in traffic accidents, while practicing sports….
In children, skull fracture is caused in most cases by a fall, either while playing, cycling, skating… It is estimated that more than half of the fractures in children are caused by falls. In the case of adults, it is also a frequent cause, although incomparable to the case of those over 65 years of age, in which more than 80% of skull fractures are caused by a fall.
The second cause of these injuries is an accident in which a heavy or blunt element ends up impacting the patient’s head, such as a golf ball, a falling debris… In this case, the trauma or accident is strong, so it overcomes the elasticity of the skull bones, breaking them and causing the fracture.
Car accident is the third leading cause of this pathology, although usually the brain damage generated in a car accident is really severe.
Can it be prevented?
A skull fracture cannot be prevented, since it is caused by an accident or trauma. However, there are useful measures that can serve to keep the individual protected. Some of them are:
- Use seat belts and special seats in children in automobiles.
- Wearing a helmet when doing sports such as climbing or contact sports. Helmets should be worn when riding bicycles and motorcycles.
- Use special protective equipment for each sport
Treatments for skull fracture
Patients with a skull fracture but no brain injury are admitted to the hospital to monitor their condition and progress. It should be noted that most skull fractures do not require a specific treatment, with the exception of the fracture with subsidence or depression, the fracture at the base of the skull and the compound fracture.
In the case of a depressed fracture, the bone or fragments of the skull press internally on the brain, injuring it. In turn, part of the brain is exposed to the outside, and abscesses and infection may form in the area. Foreign material and dead tissue must be removed and the wound treated as far as possible. Subsequently, the sunken skull will be lifted and put in place, the wound will be sutured and observation of the patient’s evolution will begin.
In fractures of the base of the skull, the patient should be put at rest with the head raised, waiting for the cerebrospinal fluid leakage to stop. If there is a meningeal tear, it normally closes by itself between two days and one week after the trauma. In the event that the flow of cerebrospinal fluid does not stop, the specialist may try to remove it by inserting a small needle in the lumbar area. In the event that it cannot be removed with the needle, the specialist may choose to initiate extraction surgery.
Which specialist treats a skull fracture?
The specialized physician in charge of treating skull fractures and its derived problems is the Neurosurgeon.