Skull Fracture: Skull fractures are categorized as linear, depressed, or basilar, and may or may not involve injury to the brain tissue. Linear fracture, the most common type of fracture, does not affect brain tissue. Depressed fractures occur when an object fractures the bone with sufficient force to push fragments into the brain; these are commonly open fractures that involve underlying brain tissue. The temporal bone is the most commonly fractured bone of the skull. Basilar fractures, fractures at the base of the skull, occur in the temporal bone.
Physical Assessment:
- Basilar skull fractures may produce “Battle’s sign,” which is bruising of the mastoid process behind the ear on the affected side. There may also be a CSF leak from the ear.
- Fractures in the frontal fossa can result in periorbital ecchymosis, referred to as “raccoon eyes,” edema, and CSF leak from the nose.
Diagnosis:
- Complete neurological examination, including GCS.
- skull x ray
- CT scan
- MRA if vascular injury is suspected
Signs and Symptoms:
- Bruising, headache, edema, rhinorrhea (nasal CSF discharge), or otorrhea (ear CSF discharge) may be present.
- LOC is variable according to the area of injury.
Treatment:
- Linear fractures need little treatment except pain relief and instructions to check for any late-developing neurological deficits.
- Depressed fracture may require surgery and prophylactic antibiotics.
- Craniotomy or craniectomy may be needed if intracranial bleeding or swelling is a problem.