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At least 19 recordsLinked to original sources
PubMed2001

[Spontaneous resolution of a congenital depressed skull fracture].

Congenital depressed skull fracture is rare and in most cases its etiology remains unclear. We present a female newborn infant with a congenital depressed skull fracture and no evidence of antepartum or intrapartum traumatism. The baby had normal neurological status and the depressed fracture healed spontaneously in a few weeks. Based on our experience of this case and a literature review, we conclude that congenital depressed skull fractures should be managed conservatively if the skull depression is less than 2cm, there is no previous trauma, no local edema or hematoma, and if the neonate shows normal neurological status.

Female↗
PubMed1983

Clinical and experimental morphological study of depressed skull fracture.

Ninety-eight cases of depressed skull fractures, caused by various accidents, were treated. The morphological structures of the fractures were studied. Thirty-four depressed fractures were established experimentally, and a comparable study was performed. Clinically and experimentally I confirmed the same morphological reactions, that is, that the fractures of the inner region were always larger than those of the outer side, as a result of the direction of the impacting forces. The human skull suffers depressed fractures only because it has "HSH" (hard-soft-hard) histological structures. It is naturally disadvantaged.

Humans↗
PubMed1976

Compound depressed skull fracture.

Although compound depressed skull fractures are common and their management and diagnosis have been described at length, their occurrence following dog bites is unusual. The case of an 18-month-old infant with this injury as a complication of multiple dog bites in the facial and head regions is described with the treatment employed. The necessity of searching for skull fractures in children following dog bites in this region is emphasized.

Animals↗
PubMed1982

Intrauterine depressed skull fractures of the newborn.

Intrauterine depressed skull fractures are reported only occasionally. In reviewing the literature it seems clear that pressure of the fetal head against the maternal bony structures, mainly the sacral promontory, accounts for most of the so-called "spontaneous" congenital depressed skull fractures. Rather than true fractures, they are focal congenital moulding depressions. On the other hand, trauma to the mother's abdomen and traumatic delivery are accepted pathological mechanisms for such lesions; most commonly they are ascribed to inexpert application of the forceps blades or undue force by the obstetrician at the time of birth. In some cases, however, uncomplicated spontaneous vaginal or cesarean section deliveries have surprisingly and unexpectedly yielded infants with depressed skull fractures. Three such cases are reported, and the literature is reviewed.

Birth Injuries↗
PubMed1999

Revival of non-surgical management of neonatal depressed skull fractures.

The management of depressed skull fractures in the newborn infant can be controversial. We report on a neonate, born by Caesarean section with difficult head extraction, complicated by a parietal depressed fracture. This 'ping-pong' fracture was treated by elevation with an obstetrical vacuum extractor. No complications occurred. The possible treatment modalities for neonatal depressed fractures, being conservative or operative, will be discussed.

Adult↗
PubMed1999

Infection rate with replacement of bone fragment in compound depressed skull fractures.

BACKGROUND: Traditional management of compound depressed skull fractures entails elevation and removal of all bone fragments with delayed cranioplasty. Bone fragment removal is intended to reduce the potential for infection. However, bone fragment removal often necessitates a second operation to repair the resultant calvarial defect. This study examines the postoperative infection rate when bone fragments are replaced primarily. METHODS: A retrospective study was carried out of all patients admitted with the diagnosis of compound depressed skull fracture to a university hospital from 1991 to 1996. RESULTS: Of 52 patients with the diagnosis of compound depressed skull fracture treated at our university hospital over the past 5 years, 32 underwent elevation and repair within 72 hours. All patients except one received antibiotics during surgery and for at least 1.5 days after surgery. Follow-up averaged just over 22 months. In all 32 consecutive patients treated with debridement and elevation of compound depressed skull fractures with primary replacement of bone fragments within 72 hours of injury, there were no infectious sequelae. CONCLUSIONS: Immediate replacement of bone fragments in compound depressed skull fractures does not increase the risk of infectious complications.

Adolescent↗
PubMed1987

Management of simple depressed skull fractures in children.

Surgical elevation is the treatment usually recommended for a simple depressed skull fracture if the depression is more than the full thickness of the adjacent skull, but there is no clinical evidence to support this management. On that basis, a progressively more conservative approach to the treatment of this condition was adopted, especially in young children. Experience with this mode of management over the period 1972 to 1984 is presented. Of 111 patients under 16 years of age with depressed skull fractures, 64 had simple and 47 compound fractures. Simple depressed skull fractures occurred in a younger age group after less significant trauma than compound fractures. In those patients who were treated surgically, there was an 11% incidence of dural laceration in patients with simple depressed fractures versus 67% for the patients with compound depressed fractures. There was no difference in outcome between surgically and nonsurgically treated patients with simple depressed fractures with respect to the occurrence of seizures, neurological dysfunction, or cosmetic appearance. Surgical treatment prolonged hospitalization, and the only case with a fatal outcome was found in the group of patients treated surgically. It is suggested that the standard treatment of simple depressed skull fractures in the pediatric age group should not include surgery. Surgery is indicated when there is definite evidence of dural penetration and in the older child with an unacceptable cosmetic appearance.

Child↗
PubMed1993

Nonsurgical treatment of compound depressed skull fractures.

Classical treatment of compound depressed skull fractures includes debridement and closure of all scalp wounds to minimize the risk of delayed intracranial infection. In selected situations, a nonsurgical approach may prove to be equally safe. Over a 33-month period, we evaluated 1075 patients for head trauma. There were 63 patients with non-missile, compound depressed skull fractures (9 of these 63 patients have been excluded for deaths that occurred within 4 days of admission). Patients with significant intracranial hematomas or dural violations over the convexity of the brain underwent formal surgical therapy. Surgical therapy was performed on 28 patients (52%; age 33 +/- 3 years; ISS 24 +/- 2) and it consisted of craniotomy with debridement, elevation of depressed fragments, repair of dural tears, and evacuation of hematomas. Nonsurgical treatment was used if there was no evidence of violation of the dura mater and of significant intracranial hematoma. If the following criteria were satisfied, then the nonsurgical approach was employed: no evidence of exposed brain or a cerebrospinal fluid leak, no pneumocephalus related to the fracture, no depressed fragments of bone more than 1 cm below the inner table of the skull, and no gross wound contamination. Nonsurgical therapy was used on 26 patients (48%; age 34 +/- 3 years; ISS 19 +/- 2) and it consisted of wound irrigation, debridement, and closure. In all 54 patients of both subsets of patients, intravenous antibiotics were administered for 5 to 7 days. After two additional days of observation, off antibiotics, the patients were discharged. There were no infectious complications related to the central nervous system.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Comparison of "instrument-associated" and "spontaneous" obstetric depressed skull fractures in a cohort of 68 neonates.

OBJECTIVE: A depressed skull fracture is an inward buckling of the calvarial bones and is referred to as a "ping-pong" fracture. This study aimed to look at differences between "spontaneous" and "instrument-associated" depressed skull fractures. STUDY DESIGN: This retrospective, case-control analysis included every neonate who was admitted with a depressed skull fracture between 1990 and 2000. Cases after a spontaneous vaginal delivery, elective cesarean delivery, or cesarean delivery that was performed during labor without previous instrument use were classified as "spontaneous" (n = 18 cases). Cases after a delivery in which forceps or a vacuum cup had been used either successfully or unsuccessfully were classified as "instrument-associated" (n = 50 cases). Continuous data were analyzed with 2-tailed unpaired t tests; chi 2 analysis was used for nominal data. A probability value of <.05 was considered statistically significant. RESULTS: Fifty depressed skull fractures were associated with an instrument delivery, and 18 depressed skull fractures were classified as "spontaneous." The only obstetric parameter that differed significantly between the 2 groups was the length of the active phase. Among the 68 neonates, 15 neonates underwent prolonged second stage, forceps or manual head rotation, or forceps use during elective cesarean delivery. All "instrument-associated" cases were caused by forceps application or sequential instrument use; depressed skull fractures never occurred after isolated vacuum extraction. Every type of forceps was involved. Intracranial lesions were significantly more frequent in the instrument-associated group (30% vs 0%; P = .02). Two infants sustained persistent severe motor disabilities. CONCLUSION: Depressed skull fractures occur in the setting of spontaneous and operative deliveries, although the incidence is higher in the latter case. Depressed skull fractures that are associated with instrumental deliveries are significantly more likely to be associated with intracranial lesions. Persistent disabilities are rare.

Birth Injuries↗
PubMed1993

Immediate bone replacement in compound depressed skull fractures.

Twelve patients with compound depressed skull fractures whose post-debridement cranial defects were treated with immediate bone replacement (IBR) are described. All were fully conscious on admission and except one who had debridement two days after injury, all had surgery within 24 hours of wounding. None had post-operative wound infection or osteomyelitis of the replaced bone fragment. Four patients with severe or moderately severe head wounds had the comminuted free fragments removed without replacement. Primary repair of skull defects with bone fragments is recommended as the treatment of choice during debridement of compound depressed skull fractures of mild to moderate severity which present in hospital within 24 hours of injury.

Adolescent↗
PubMed2005

Rational management of simple depressed skull fractures in infants.

OBJECT: The management regimen for depressed skull fractures in infants can be conservative or surgical. The aim of this study was to provide a rational principle of management for simple depressed skull fractures in infants. METHODS: A protocol of nonsurgical treatment for a simple depressed skull fracture was designed for all affected infants during the period from 1985 to 2001. Conservative management was used for those with a depressed fracture measuring less than 5 mm in depth, whereas vacuum extraction was applied for larger and deeper depressions. All of the patients were evaluated for initial results and later outcomes. Twenty-five infants suffering simple depressed skull fractures were consecutively enrolled. According to our protocol, 11 patients received conservative management by close observation only. Spontaneous restoration of the depression was observed in eight patients within a period of 1 to 6 months. For the remaining 14 patients, vacuum extraction was performed. A negative pressure of 0.3 to 0.8 kg/cm2 (mean 0.49 kg/cm2) was applied for a duration of 20 to 90 seconds (mean 43.6 seconds). All but one patient experienced complete recovery following extraction. The depressions of the four patients that were residual after initial management smoothed out with time. No neurological deficit or later epilepsy was noted in any patient. CONCLUSIONS: Nonsurgical management can be the treatment of choice for infants with simple depressed skull fractures, whereas vacuum extraction is one option for larger and deeper depressions to obtain prompt resolution and relieve major family anxiety, without taking additional risks.

Female↗
PubMed1999

Delayed repair of open depressed skull fracture.

INTRODUCTION: Elevation and repair of an open depressed skull fracture is often thought of as an emergency procedure. Common indications for emergent elevation of a depressed skull fracture have been dural tear, seizure, gross contamination or mass effect from bone or a sizable underlying intracerebral hematoma. As treatment of head injury moves towards management of cerebral perfusion pressure (CPP) rather than intracranial pressure (ICP), we sought a way to maximize CPP in the initial treatment of head-injured patients with depressed skull fractures that would eventually require surgery by delaying surgery, when possible, until after the initial period of elevated ICP. METHODS: Over a 12-month period, 7 patients (all male, ages 1-15 years) were admitted to our institution with the diagnosis of open depressed skull fracture without significant mass effect requiring urgent decompression. All had significant head trauma with altered mental status and a Glasgow Coma Score of 3-12. Patients were treated with antibiotic prophylaxis (nafcillin, ceftriaxone, metronidazole), seizure prophylaxis (phenytoin) and underwent CPP management in an intensive care unit setting as indicated by intracranial pressure monitoring or clinical assessment. Length of medical management of CPP ranged from 4 to 12 days. Upon stabilization of CPP, patients were operated for repair of their dural, bone and scalp injuries. RESULTS: All 7 patients treated in the above manner suffered no ill effects from their delayed surgery: there was no meningitis, no late seizures, and no cerebrospinal fluid leak. Complications attributable to delay were not present at follow-up ranging from 12 to 24 months. CONCLUSIONS: We have delayed surgery for repair of open depressed skull fractures in order to maximize medical management of CPP in the setting of acute trauma. Among other considerations, the risk of intraoperative hypotension occurring at a time of acutely raised ICP was avoided by this delay. We conclude that there is a role, in this specifically defined subset of head trauma patients, for delayed surgical repair of open depressed skull fractures.

Adolescent↗
PubMed2005

Simple depressed skull fracture causing sagittal sinus stenosis and increased intracranial pressure: case report and review of the literature.

The surgical management of depressed skull fractures is determined in part by whether a fracture is open or closed. Open fractures are usually elevated surgically, but closed fractures are most often treated nonoperatively, and the only 2 indications commonly described for operative treatment of closed fractures are hematoma evacuation and correction of cosmetic deformity. There is another indication, however, that is occasionally encountered when a depressed skull fracture injures a venous sinus. This injury can result in venous sinus stenosis, leading to venous hypertension and elevated intracranial pressure (ICP). A case is presented of closed depressed fracture of the midline skull, causing compressive stenosis of the superior sagittal sinus (SSS), venous hypertension, and encephalopathy. The fracture was surgically elevated to relieve the compression of the SSS and the encephalopathy resolved. The clinical identification, the imaging, and the risks and benefits of operative repair of this condition are reviewed. Increased ICP secondary to venous sinus injury is not commonly described in association with closed depressed skull fractures, but should always be considered in patients with the appropriate clinical findings when a fracture overlies a venous sinus, even in the absence of a hematoma.

Adult↗
PubMed2004

[Superior sagittal sinus occlusion caused by a compound depressed skull fracture: a case treated by emergency surgery].

Depressed skull fractures compressing major venous sinuses are rare, and the treatment is a matter of controversy. The majority of depressed fractures are treated conservatively for fear of bleeding from venous sinuses, but surgical intervention was conducted in a few cases. We report a case of a 59-year-old man with a compound depressed fracture occluding the superior sagittal sinus (SSS). The patient was struck on the head by a heavy iron bar and admitted to our emergency center because of deterioration of consciousness. A computed tomographic scan showed depressed skull fracture overlying the SSS with hemorrhagic lesions in the bilateral parietal lobes and an acute epidural hematoma at the right temporoparietal convexity. Digital subtraction angiography (DSA) showed an occlusion of the SSS and compensatory venous drainage associated with poor capillary filling in the left parietal lobe. On an emergency basis, bone fragments compressing the SSS were surgically removed piece-by-piece to resolve severe venous congestion and to avoid infection. A small tear in the SSS was treated by head elevation and compressing the SSS with Gelfoam. Postoperative DSA confirmed the patency of the SSS and normal blood flow in the left parietal lobe. The patient exhibited slight disorientation and was transferred to another hospital for further rehabilitation. Because of symptomatic severe venous congestion, we had to perform emergency surgical decompression and removal of bone fragments. Treatment strategy for depressed skull fracture with SSS involvement was discussed with review of the literature.

Decompression, Surgical↗
PubMed1996

Pediatric depressed skull fractures: analysis of 530 cases.

Depressed skull fractures (DSFs) account for 7-10% of children admitted to hospital with a head injury and 15-25% of children with skull fractures. We reviewed the records of 530 patients operated on for DSF from January 1, 1973, to December 31, 1993. This group was made up of 357 boys (67%) and 173 girls (33%) whose ages ranged from 1 day to 16 years (mean age 6.1 years). Fall was the most common cause of injury. Of the 530 patients with DSF, 66% had compound fractures. The incidence of compound fractures increased with age. Compound fractures caused more brain lacerations (29%) than simple fractures (15.5%) did. We also classified DSFs radiologically as true, flat, or ping-pong ball fractures. Associated intracranial lesions were found to be a bad prognostic factor. There were 13 deaths (2.5%) in this series. Satisfactory results were achieved in over 95% of the patients. Compound fractures are associated with a worse outcome and a higher incidence of intracranial lesions and cortical laceration. Unilateral pupillary dilatation and an admission GCS score of 8 or less are ominous signs in regard to mortality. We also found that the deeper the depressed bone, the higher the risk of both dural tear and cortical laceration and the worse the prognosis. A conservative approach should be followed in cases of simple DSF without associated intracranial hematoma and in cases in which the bone depression is not deeper than 1 cm.

Adolescent↗
PubMed2006

Depressed skull fractures in children: Treatment using an obstetrical vacuum extractor.

INTRODUCTION: A depressed skull fracture is an inward buckling of the skull bones. It is referred to as a ping-pong ball fracture in neonates; in older children, some fractures take a cup shape mimicking 'ping-pong' ball fractures. OBJECTIVE AND METHODS: The aim of this study was to assess the use of an obstetric vacuum extractor to elevate cup-shaped depressed skull fractures in children irrespective of age. All children admitted into the Central Hospital of Yaounde between 1999 and 2004 with a cup-shaped simple depressed skull fracture and treated with the vacuum extractor were included. RESULTS: Nine children aged from 3 months to 17 years were treated with the vacuum extractor. The cosmetic and radiographic results were satisfactory. The procedure was simple and without any complication. CONCLUSION: The elevation of 'ping-pong-ball-like' or 'cup-shaped' skull fractures in older children (beyond the neonatal period) is a simple, effective and safe procedure.

Adolescent↗