Skull fracture: Difference between revisions

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''For pediatric patient, see [[Skull fracture (peds)]]''
{{Adult top}} [[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|Basilar Skull Fracture]]===
*Raccoon eyes
*Battle sign
*Hemotympanum
*Clear [[rhinorrhea]] or otorrhea may indicate CSF leak from dural tear associated with fracture


==Differential Diagnosis==
==Differential Diagnosis==
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==Evaluation==
==Evaluation==
*[[CT head]]
*CBC
*Coags
*Evaluate for additional injuries


==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


==Management==
===Depressed Skull Fracture===
*Neurosurgery consult
*[[Antibiotics]], seizure prophylaxis (e.g. [[Keppra]]), 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==
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==References==
==References==
<references/>
<references/>
[[Category:Trauma]][[Category:Orthopedics]][[Category:Neurology]]

Revision as of 20:50, 11 November 2020

This page is for adult patients. For pediatric patients, see: skull fracture (peds).

Background

Bones of the cranium.
  • 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 otorrhea may indicate CSF leak from dural tear associated with fracture

Differential Diagnosis

Head trauma

Maxillofacial Trauma

Evaluation

  • CT head
  • CBC
  • Coags
  • Evaluate for additional injuries

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 (e.g. Keppra), 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

See Also

External Links

References