Skull fracture

• Alternative Names

  Basilar skull fracture; Depressed skull fracture; Linear skull fracture

• Considerations

  Skull fractures may occur with head injuries. Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull. It may be accompanied by injury to the brain.

  The brain can be affected directly by damage to the nervous system tissue and bleeding. The brain can also be affected indirectly by blood clots that form under the skull and then compress the underlying brain tissue (subdural or epidural hematoma).

  A simple fracture is a break in the bone without damage to the skin.

  A linear skull fracture is a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone.

  A depressed skull fracture is a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brain.

  A compound fracture involves a break in, or loss of, skin and splintering of the bone.

• Causes
  • Head trauma
  • Falls, automobile accidents, physical assault, and sports
• Symptoms
  • Bleeding from wound, ears, nose, or around eyes
  • Bruising behind the ears or under the eyes
  • Changes in pupils (sizes unequal, not reactive to light)
  • Confusion
  • Convulsions
  • Difficulties with balance
  • Drainage of clear or bloody fluid from ears or nose
  • Drowsiness
  • Headache
  • Loss of consciousness
  • Nausea
  • Restlessness, irritability
  • Slurred speech
  • Stiff neck
  • Swelling
  • Visual disturbances
  • Vomiting

  Note: The only symptom may be a bump on the head. A bump or bruise may take up to 24 hours to develop.

• First Aid

  1. Check the airways, breathing, and circulation. If necessary, begin rescue breathing and CPR.

  2. Avoid moving the victim (unless absolutely necessary) until medical help arrives. Instruct someone to call 911 (or the local emergency number) for medical assistance.

  3. If the victim must be moved, take care to stabilize the head and neck. Place your hands on both sides of the head and under the shoulders. Do not allow the head to bend forward or backward, or to twist or turn.

  4. Carefully check the site of injury, but do not probe in or around the site with a foreign object. It can be difficult to know if the skull is fractured or depressed (dented in) at the site of injury.

  5. If there is bleeding, apply firm pressure with a clean cloth to control blood loss over a broad area.

  6. If blood soaks through, do not remove the original cloth. Instead, apply additional cloths on top, and continue to apply pressure.

  7. If the victim is vomiting, stabilize the head and neck (as outlined in number 3, above), and carefully turn the victim to the side to prevent choking on vomit.

  8. If the victim is conscious and experiencing any of the previously listed symptoms, transport to the nearest emergency medical facility (even if the patient does not think medical assistance is necessary).

• Do Not
  • Do NOT move the victim unless absolutely necessary -- head injuries may be associated with spinal injuries.
  • Do NOT remove protruding objects.
  • Do NOT allow the victim to continue to engage in physical activities.
  • Do NOT forget to observe the victim closely until medical help arrives.
  • Do NOT give the victim any medications before consulting a physician.
  • Do NOT leave the victim alone, even if there are no complaints or obvious injuries.
• Call immediately for emergency medical assistance if
  • There are problems with breathing or circulation.
  • Direct pressure does not stop bleeding from the nose, ears, or wound.
  • There is drainage of clear fluid from the nose or ears.
  • There is facial swelling, bleeding, or bruising.
  • There is an object protruding from the skull.
  • The victim is unconscious, is experiencing convulsions, has multiple injuries, appears to be in any distress, or is not lucid.
• Prevention

  1. Use car seats or seat belts whenever in a motor vehicle.

  2. Use helmets whenever biking, skating, skiing, climbing, or playing contact sports.

  3. Use equipment designed specifically for the type of sport or recreation in which you are participating.

  4. Provide appropriate supervision for children of any age.

  5. Do not allow children to bike or skate at night.

  6. Provide and wear highly visible clothing.

  7. Teach children to obey traffic rules and signals.

  8. Educate individuals about risks of various work, recreational, or sport activities and how to avoid injury.

  9. Report any concerns you might have about abuse.

• References

  Biros MH, Heegaard WE. Head injury. In: Marx JA, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 38.

  Leveque JC. Hoff JT. Neurosurgery. In: Greenfield LJ, Mulholland MW, Oldham KT, Zelenock GB, Lillemoe KD, eds. Greenfield's Surgery: Scientific Principles and Practice. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2005:chap 114.

Review Date: 1/14/2010

Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.