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
- Traumatic brain injury
- Orbital trauma
- Maxillofacial trauma
- Skull fracture
- Pediatric head trauma
- PECARN head trauma rule
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
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
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