Skull fracture: Difference between revisions
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''This page is for adult patients; for pediatric patients see [[skull fracture (peds)]]'' | |||
==Background== | ==Background== | ||
[[File:Cranial bones en.png|thumb|Bones of the cranium.]] | |||
*Presence of skull fracture significantly increases risk of underlying intracranial injury | |||
==Clinical Features== | ==Clinical Features== | ||
===Linear Skull Fracture=== | |||
*Often have scalp hematoma or tenderness to palpation | |||
===Depressed Skull Fracture=== | |||
*Depression or crepitus may be palpable on physical exam | |||
===Basilar Skull Fracture=== | |||
*Raccoon eyes | |||
*Battle sign | |||
*Hemotympanum | |||
*Clear rhinorrhea or ottorhea may indicate CSF leak from dural tear associated with fracture | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Head trauma DDX}} | |||
{{Maxillofacial trauma DDX}} | |||
==Evaluation== | ==Evaluation== | ||
*CT head | |||
*CBC | |||
*Coags | |||
==Management== | |||
===Linear Skull Fracture=== | |||
*If no intracranial bleed or other injuries, observe for 4-6 hrs and discharge | |||
**Patients with advanced age, coagulopathy, or other co-morbidities may benefit from admission | |||
== | ===Depressed Skull Fracture=== | ||
*Neurosurgery consult | |||
*Antibiotics, seizure prophylaxis, surgery/wound debridement may be indicated in discussion with a neurosurgeon | |||
===Basilar Skull Fracture=== | |||
*Neurosurgery consult | |||
*Antibiotic prophylaxis is often started in setting of CSF leak but should be discussed with a neurosurgeon | |||
==Disposition== | ==Disposition== | ||
*Admit - except for simple linear skull fracture with no other injuries | |||
==See Also== | ==See Also== | ||
Revision as of 21:11, 18 July 2019
This page is for adult patients; for pediatric patients see skull fracture (peds)
Background
- Presence of skull fracture significantly increases risk of underlying intracranial injury
Clinical Features
Linear Skull Fracture
- Often have scalp hematoma or tenderness to palpation
Depressed Skull Fracture
- Depression or crepitus may be palpable on physical exam
Basilar Skull Fracture
- Raccoon eyes
- Battle sign
- Hemotympanum
- Clear rhinorrhea or ottorhea may indicate CSF leak from dural tear associated with fracture
Differential Diagnosis
Head trauma
- Traumatic brain injury
- Orbital trauma
- Maxillofacial trauma
- Scalp laceration
- Skull fracture
- Pediatric head trauma
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
- CT head
- CBC
- Coags
Management
Linear Skull Fracture
- If no intracranial bleed or other injuries, observe for 4-6 hrs and discharge
- Patients with advanced age, coagulopathy, or other co-morbidities may benefit from admission
Depressed Skull Fracture
- Neurosurgery consult
- Antibiotics, seizure prophylaxis, surgery/wound debridement may be indicated in discussion with a neurosurgeon
Basilar Skull Fracture
- Neurosurgery consult
- Antibiotic prophylaxis is often started in setting of CSF leak but should be discussed with a neurosurgeon
Disposition
- Admit - except for simple linear skull fracture with no other injuries