Skull fracture

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