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At least 19 recordsLinked to original sources
PubMed1995

Mechanisms of basilar skull fracture.

Basilar skull fractures comprise a broad category of injuries that have been attributed to a variety of causal mechanisms. The objective of this work is to develop an understanding of the biomechanical mechanisms that result in basilar skull fractures, specifically focusing on mandibular impact and neck loading as potential mechanisms. In the characterization of the injury mechanisms, three experimental studies have been performed. The first study evaluated the response of the base of the skull to midsymphysis loading on the mental protuberance (chin) of the mandible. Five dynamic impacts using a vertical drop track and one quasi-static test in a servohydraulic test frame have been performed. In each test, clinically relevant mandibular fractures were produced but no basilar skull fractures were observed. The second study assessed the fracture tolerance of the base of the skull subject to direct loading on the temporomandibular joint in conjunction with tensile loading imposed locally around the foramen magnum to simulate the effect of the ligaments and musculature of the neck. Among four specimens that sustained either complete or incomplete basilar skull ring fractures remote from the sites of load application, the mean load at fracture was 4300 +/- 350 N. Energy to fracture was computed in three of those tests and averaged 13.0 +/- 1.7 J. Injuries produced were consistent with clinical observations that have attributed basilar skull ring fractures to mandibular impacts. In the third series of experimental tests, loading responses resulting from cranial vault impacts were investigated using unembalmed human cadaver heads and ligamentous cervical spines. Multiaxis load cells and accelerometers, coupled with high-speed digital video, were used to quantify impact dynamics. The results of these experiments suggest that while there is a greater probability of cervical spine injury, basilar skull ring fractures can result when the head is constrained on the impact surface and the inertia of the torso drives the vertebral column onto the occiput.

Biomechanical Phenomena↗
PubMed1992

How much monitoring is needed for basilar skull fractures?

Basilar skull fractures account for approximately 19% of all skull fractures. There have been little data published concerning the need for intensive care monitoring in this injury. We retrospectively studied 259 patients admitted to our trauma center over an 8-year period with a diagnosis of basilar skull fracture. All patients were evaluated with cranial computed tomographic (CT) scans. These patients were admitted to the trauma service, and neurosurgical consultation was obtained in all cases. The diagnosis was made by clinical signs in 207 patients (80%), by CT scan in 47 (18%), and by plain films in 5 (2%). Ninety-two patients (group I) had intracranial pathology in addition to basilar skull fracture. Twenty-one patients in this group underwent craniotomy. In this group, the morbidity and mortality rates were 11% and 7%, respectively. Forty-four patients (group II) had no intracranial pathology and a Glasgow Coma Score (GCS) of less than 13. The morbidity was 2%, and the mortality was 2%. One hundred twenty-three patients (group III) had no intracranial pathology on CT scan and a GCS of 13 or greater. The complication rate in this group was 1%, and there was no neurologically related mortality. Patients who are admitted with a diagnosis of basilar skull fracture and who have a GCS of 13 or greater with no intracranial pathology on CT can be managed without intensive care monitoring.

Adolescent↗
PubMed2006

Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures.

BACKGROUND: Basilar skull fractures (BSF) predispose patients to meningitis because of the possible direct contact of bacteria in the paranasal sinuses, nasopharynx or middle ear with the central nervous system (CNS). Cerebrospinal fluid (CSF) leakage has been associated with a greater risk of contracting meningitis. Antibiotics are often given prophylactically, although their role for preventing bacterial meningitis is not established. OBJECTIVES: To evaluate the effectiveness of prophylactic antibiotics for preventing meningitis in patients with BSF. SEARCH STRATEGY: We searched the Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to September 2005), EMBASE (1974 to June 2005), and LILACS (1982 to September 2005). We also performed an electronic search of meeting proceedings from the American Association of Neurological Surgeons (1997 to September 2005) and handsearched the abstracts of meeting proceedings of the European Association of Neurosurgical Societies (1995, 1999 and 2003). SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing any antibiotic versus placebo or no intervention. We also identified non-RCTs to perform a separate meta-analysis to compare results. DATA COLLECTION AND ANALYSIS: At least two authors independently appraised the quality and extracted the data of each trial. MAIN RESULTS: Five RCTs and 17 non-RCTs comparing different types of antibiotic prophylaxis with placebo or no intervention in patients with BSF were identified. Most trials presented insufficient methodological detail. All studies included meningitis in their primary outcome. Overall, we evaluated 208 participants from the four RCTs that were considered suitable for inclusion in the meta-analysis. There were no significant differences between antibiotic prophylaxis groups and control groups in terms of reduction of the frequency of meningitis, all-cause mortality, meningitis-related mortality, and need for surgical correction in patients with CSF leakage. We performed a subgroup analysis to evaluate the primary outcome in patients with and without CSF leakage. We also completed a meta-analysis of all the identified controlled non-RCTs (enrolling a total of 2168 patients), producing results consistent with the randomised data. AUTHORS' CONCLUSIONS: Currently available evidence from RCTs does not support prophylactic antibiotic use in patients with BSF, whether there is evidence of CSF leakage or not. Until more research is completed, the effectiveness of antibiotics in patients with BSF cannot be determined because studies published to date are flawed by biases. Large, appropriately designed RCTs are needed.

Antibiotic Prophylaxis↗
PubMed1998

Antibiotic prophylaxis after basilar skull fractures: a meta-analysis.

Antibiotic prophylaxis after basilar skull fractures remains controversial. Previous studies have not clearly delineated the utility of prophylactic antibiotics in this setting. We undertook this study to determine if antibiotic prophylaxis after basilar skull fractures prevented meningitis. We performed a formal systematic review of previously published studies after a computerized search with use of the MEDLINE data base (1970-1996). Fourteen studies were identified, and 12 studies met the criteria for inclusion. Study design and quality were assessed by two independent investigators with use of a predetermined protocol. A total of 1,241 patients with basilar skull fractures were included; 719 patients received antibiotics, and 522 patients did not receive antibiotics. Overall results suggest that antibiotic prophylaxis did not prevent meningitis among patients with basilar skull fractures (odds ratio [OR] = 1.15; 95% confidence interval [CI] = 0.68-1.94; P = .678). Patients with basilar skull fractures and cerebrospinal fluid leakage were analyzed separately (OR = 1.34; 95% CI = 0.75-2.41; P = .358), as were children (OR = 1.04; 95% CI = 0.07-14.90; P = 1.000). Antibiotic prophylaxis after basilar skull fractures does not appear to decrease the risk of meningitis.

Antibiotic Prophylaxis↗
PubMedDate not supplied

[Basilar skull fractures: clinical and prognostic aspects].

The incidence of basilar skull fractures and their clinical and prognostic aspects were studied in victims with varying severity of brain injury. Of 947 cases, 449 (46%) patients were diagnosed as having basilar skull fracture and 181 (18.6%) had basal spinal fluid leakage. The frequency of fractures and basal spinal fluid leakage increased in proportion to the severity of brain injury. The above 14-day history of spinal fluid leakage was an absolute indication for surgical fistula closure.

Adolescent↗
PubMed1978

Basilar skull fractures in children. The incidence of CNS infection and the use of antibiotics.

Forty-six cases of basilar skull fractures in children were reviewed to determine the incidence of CNS infection following injury and the possible value of antimicrobial chemoprophylaxis. The clinical course of the children who were treated with antibiotics was compared with that of patients who received no antimicrobial therapy. Included in the study were patients with hemotympanum alone or with hemotympanum plus additional clinical or roentgenographic signs of basilar skull fracture; patients with tympanic membrane perforation without otorrhea but with blood in the auditory canal; and children with either otorrhea or rhinorrhea. Acute, delayed, or recurrent infection of the CNS did not develop in any of the patients. This study is the first of its kind presented in children. It would seem on the basis of the present series that the systematic use of antibiotic prophylaxis in children with hemotympanum following basilar skull fractures is unwarranted and that children with other signs of basilar skull fractures may have an equally small risk of meningitis following injury.

Adolescent↗
PubMed2002

Longitudinal brainstem laceration associated with complex basilar skull fractures due to a fall: an autopsy case.

This report describes an autopsy case of a rare longitudinal brainstem laceration associated with complex basilar skull fractures. The victim was a 40-year-old male who died immediately after falling from a roof (9.2m in height) of a factory onto a concrete floor. The postmortem examination revealed an incomplete ring fracture of the base of the skull with longitudinal fractures of the sphenoid (clivus of the dorsum sellae turcicae) and occipital bones, cerebral contusions in the frontal and temporal poles, a longitudinal brainstem laceration at the posterior median sulcus of the pons accompanied with multiple contusional hemorrhages in the brainstem and corpus callosum. Related blunt-force injuries were observed in the parieto-occipital region of the head, shoulder and upper back involving the fractures of the cervical and thoracic vertebrae, and sternum and ribs, indicating a huge impact to the occiput and subsequent impression of the vertebral column into the base of the skull due to violent anteroflexion of the neck, which caused the complex basilar skull fractures, contusions and longitudinal laceration of the brainstem.

Accidental Falls↗
PubMed1980

Basilar skull fractures in three horses.

Of three horses with basilar skull fractures, two died within 48 hours. The remaining horse was euthanatized because of a locomotion deficit. Clinical signs included epistaxis followed by ataxia. In each case, the basi-occipital bone and ventral portion of the calvarium were involved in the fracture. Diagnosis was based on clinical signs or radiographic appearance of guttural pouches, or both.

Animals↗
PubMed1975

Analysis of the treatment of basilar skull fractures with and without antibiotics.

The efficacy of chemoprophylaxis in the treatment of basilar skull fractures was studied in 129 patients over a 2-year period; antibiotics were found ineffective in preventing central nervous system infections, and in some cases may have proved harmful. It is suggested that a more rational approach to the treatment of basilar skull fractures includes close observation of the patient for early signs of meningitis, and if these should develop, treatment with antibiotics appropriate to the organism involved.

Ampicillin↗
PubMed1989

Basilar skull fractures in children.

In this paper we are reporting a retrospective study of patients under 18 years of age managed at the Los Angeles County/University of Southern California Medical Center from January 1979 through December 1987 with the diagnosis of basilar skull fracture. Sixty-two patients with basilar skull fractures were admitted during that 7 1/2 year period. The most common etiology was pedestrain versus vehicle accidents (42%), followed by falls (27%), vehicle accidents (23%), and being hit by an object (8%). The most common physical findings were hemotympanum (58%) and bleeding in the ear canals (47%). Thirty-four percent of the patients complained of hearing loss. Cerebrospinal fluid otorrhea was noted in 16 patients (26%), while only 1 patient had cerebrospinal fluid rhinorrhea. Facial nerve paralysis was present in 8 patients (13%). Vestibular symptoms were rare. Sixty-three percent of the patients had the diagnosis confirmed by radiography. The clinical presentation, complications, management and outcome of basilar skull fractures in the pediatric population are discussed.

Adolescent↗
PubMed1993

Transsphenoid basilar skull fracture: CT patterns.

The authors studied computed tomographic (CT) scans obtained in 40 patients with transsphenoid basilar skull fractures to establish if there were reproducible patterns of fracture along lines of weakness. Medical records were reviewed. Four major fracture patterns were identified: anterior transverse (n = 22), lateral frontal diagonal (n = 7), posterior transverse (n = 16), and mastoid diagonal (n = 3). Eight patients had two fracture patterns. Eleven of 40 patients (28%) died as a result of their head injury. The diagonal patterns were statistically significantly more frequently associated with in-hospital mortality than were the transverse fractures (P = .014). Complications included blindness, cranial nerve injury, cerebrospinal fluid leak, and hearing loss. These results indicate that transsphenoid basilar skull fractures occur along reproducible lines of weakness, including a coronal plane through the anterior sphenoid body and pterygoid plates, a coronal plane through the posterior sphenoid body and clivus, and the sphenopetrosal synchondrosis.

Adolescent↗
PubMed1991

Basilar skull fractures in childhood with cranial nerve involvement.

Cranial nerve palsies developed in 23% of 73 children with basilar skull fractures. The majority occurred in patients 10 years of age or older. Our overall incidence was higher than that in a review in which basilar skull fractures were indiscriminately included with all head injuries. Our experience with meningitis was similar to that present in the literature and would seem to support avoidance of prophylactic antibiotics. Because there was no improvement in neurological deficits in patients treated with steroids (the only case of meningitis in our series was associated with steroids), we believe that their use is unwarranted. It is important to discuss the prognosis with the patient's family, because, although the majority (53.3%) of cases resolve completely, those with residual deficits can have significant morbidity.

Adolescent↗
PubMed1983

The incidence and prevention of meningitis after basilar skull fracture.

The survey of 1,077 consecutive skull fractures admitted to the Massachusetts General Hospital between July 1, 1969 and July 1, 1979 were reviewed. One hundred sixty-eight basilar skull fractures (15.6%) were diagnosed according to clinical and radiological criteria. In 128 patients with basilar skull fracture but without CSF leak, two out of 65 patients (3.1%) who received prophylactic antibiotics developed meningitis in contrast to none of 63 patients who were treated. Nine of 15 patients with otorrhea developed meningitis regardless of treatment. Of 18 patients with rhinorrhea, 13 were treated with prophylactic antibiotics and were free of meningitis but 2 of 5 patients not treated (40%) did develop meningitis. The overall incidence of CSF leak was 20.8%. There is no clear evidence to demonstrate that prophylactic antibiotics are effective in general in reducing the incidence of meningitis after basilar skull fracture with active rhinorrhea. However, the difference in the incidence of meningitis between the treated and the untreated group was noteworthy though not statistically significant. Meningitis can develop despite antibiotic prophylaxis. Additional investigation and therapy should be considered whenever the clinical situation warrants.

Adolescent↗
PubMed1978

Lethal complication from insertion of nasogastric tube after severe basilar skull fracture.

An unusual complication is presented arising from the use of a nasogastric tube in a patient with a massive basilar skull fracture. Intracranial passage of the NG tube resulted. Therefore, in the presence of a severe basilar fracture and/or significant maxillofacial trauma where the integrity of the base of the skull may be in question, one should be very hesitant to insert tubes into the nasopharynx.

Adult↗
PubMed1983

Basilar skull fracture in U.S. Army aircraft accidents.

Of the 222 flight helmets retrieved from Army aircraft accidents during 1971-79 under the Aviation Life Support Equipment Retrieval Programs, 175 were SPH-4 helmets that were analyzed for physical damage and for the relationship of damage to injury sustained by the wearer. This analysis showed that lateral impacts resulted in a significantly higher rate of serious injury (AIS greater than or equal to 4) than impacts to other regions (68% versus 46%, p less than 0.001) Lateral impacts yielded a higher rate of basilar skull fracture than impacts to other areas of the helmet (46% versus 18%, p less than 0.001). It is concluded that lack of energy-absorbing material in the lateral portions of the helmet causes the high rate of basilar skull fracture and the increased prevalence of severe injury associated with lateral impacts. The incorporation of an energy-absorbing earcup design is recommended to reduce the high rate of severe injuries associated with lateral impacts.

Accidents, Aviation↗
PubMed1995

Pediatric basilar skull fracture: do children with normal neurologic findings and no intracranial injury require hospitalization?

STUDY OBJECTIVE: To delineate complications in patients with basilar skull fractures (BSFs) and normal neurologic findings, including computed tomography (CT) scans without intracranial injury, and to assess the need for hospitalization. DESIGN: Retrospective chart review. PARTICIPANTS: All emergency department patients with the ED diagnosis or hospital discharge diagnosis of BSF. Patients were included if they had a clinical or radiographic diagnosis of BSF. A subgroup of patients ("simple BSF") with normal neurologic examination findings in the ED, Glasgow Coma Scale scores of 15, and cranial CT scans without intracranial pathology was specifically analyzed. RESULTS: We included 239 patients in the study. One hundred fourteen patients (48%) were included in the "simple BSF" subgroup. In this subgroup, vomiting (6%) was the most common complication, meningitis (1%) the most serious. There were no cases of delayed intracranial hemorrhage, and no patient with "simple BSF" required surgery. CONCLUSION: Given the relatively low frequency of serious complications, our study suggests that some patients with BSFs may not require hospital admission.

Adolescent↗