I decided to do my path log this week on skull fracture because I work weekend option shift at a large Indianapolis hospital and the CT techs see some head trauma. I thought it would be worthwhile to learn a bit about it.
There are two types of skull fractures – linear and depressed. The image on the left is of a linear fracture. The linear fracture is the most common type, making up about 75% of skull fractures. These fractures are most commonly seen in the temporal and parietal bones of the skull. In a depressed fracture (second most common type) the skull fragments are depressed below the skull and into the brain tissue (see image on right). If the depressed fracture goes deeper than the thickness of the skull bone then surgery is usually required to elevate the bone, as well as inspect the brain for signs of injury.
The patient with skull fracture may present with obvious trauma to the head. Patients lose consciousness only about half of the time with both types of fractures. Depending on where the fracture is the patient may also have neurological deficits (they tend to correspond with the area of brain injured). Obvious risks of a depressed skull fracture are foreign matter being pushed into the brain. This will leave the patient vulnerable to infection. Both linear and depressed skull fractures may result in bleeding between the layers of the brain (subdural, epidural hematomas) or bleeding into the brain (hemmorhage).
When imaging for skull fracture always look at the scan in the bone windows so you don't miss it!
Image (left) from Website: Introduction to Head CT. Accessed September 15, 2009 at http://www.med-ed.virginia.edu/courses/rad/headct/
Image (right) from Website: Downie, A. (2001). Tutorial: CT in Head Trauma. Accessed September 15, 2009 at http://www.radiology.co.uk/srs-x/tutors/cttrauma/tutor.htm
Joseph, R. (n.d.) Skull Fractures, Accessed September 15, 2009 at http://brainmind.com/SkullFractures.html
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