Skull fracture

What is it?

A skull fracture is a break or fracture in one or more bones of the skull caused by head injury. Although the skull is tough, resilient and provides excellent protection to the brain, a severe head injury can result in skull fracture. Isolated skull fractures are not very serious, but their presence may suggest underlying brain injury, which could be serious.

What are the symptoms?

Bleeding from the wound – nose, ears or around the eyes Bruising behind the ears and under the eyes Headache Dizziness Confusion Difficulties with balance Nausea Loss of consciousness Drowsiness Changes in pupils of the eye Stiff neck Slurred speech Swelling Restlessness Vomiting Visual disturbance

What are the types?

There are three types of skull fracture – linear skull fracture, depressed skull fracture and basilar skull fracture. Liner skull fracture – It is a break in the cranial bone resembling a thin line, without splintering, depression, or distortion of the bone. It is the most common type of skull fracture that occurs in two-thirds of patients having head injuries. It can occur after minor head injuries like after falling, being struck by a rock, stick, or other objects; or from road accidents. Linear fracture is one of the simplest fractures and is not dangerous, if it doesn’t cause any serious injury in the brain itself. Most of the patients with linear skull fracture are asymptomatic and do not loose consciousness. Depressed skull fracture – As the name suggests, in this fracture some part of the bone may get depressed into the brain and damage the brain from inside. It could be dangerous if it causes a serious injury to the brain. A person can loose consciousness. This type of fracture usually occurs when a person is hit hard by a blunt object. Depressed skull fractures can further be classified into two categories – open and closed. Open fractures have either a skin laceration over the fracture or the fracture runs through the paranasal sinuses and the middle ear structures resulting in communication between the external environment and the cranial activity. Closed fractures are those in, which the skin does not get broken. Basilar skull fracture – This breaks the bone at the base of the skull and requires more force to be caused than cranial vault fractures. Therefore, they are very rare. Such a fracture can result in disruption of the middle ear bones resulting in conductive deafness or leakage of CSF (brain fluid) from the ears or nose.

How is the diagnosis made?

The severity of damage can be measured by computed tomography (CT) scan, MRI, EEG, PET scan, neurological and neuropsychological evaluations. Doctors use the Glasgow coma scale to measure the extent of brain damage based on observing the patients’ verbal response while talking, ability to open and close eyes, and stimulation on moving. A patient can score 3 to 15 points on this scale. People who score below 8 are diagnosed as having severe injury and need rehabilitative therapy to recover. Similarly, a person who scores high is stated as having less serious brain injury and have better chances of recovery.Patients with head injury are advised to consult a specialist, as there are chances of missed diagnosis as the mild injury cannot be seen very clearly in CT scan, MRI, EEG and neurological and neuropsychological assessments. In many cases of mild and subtle injuries, these tests can give normal results and cannot show microscopic damage of the tissues, which in later stage can make the person less efficient.

What is the treatment?

First aid Check the airway and circulation; if needed begin rescue breathing. Avoid moving the patient unless absolutely necessary. Take precautions while moving the patient. Preferably move the patient in guidance of medical help. If it is necessary to move the person, take care to stabilise the head and neck. Place your hands under both the sides of the head and shoulder. Do not allow the head to move backwards or forwards, or twist or turn. If there is bleeding, try to control it by pressing the area with a clean piece of cloth. If blood soaks through, do not remove the previous cloth; instead put the new piece of cloth over it. If the victim vomits, try to stabilise the head and neck and turn the victim carefully to prevent choking on vomit. If the victim is conscious and feeling the symptoms listed above, then take him to the nearest emergency medical facility.After the initial emergency treatment, a specialist will make the complete diagnosis of the head injury if a skull fracture is suspected. In case of a penetrating wound or a severe case of brain injury, a surgery may be required. Severe cases of brain injury with deteriorating level of consciousness, the patient should be kept under observation. If there is bleeding inside the brain or a clot is formed, they need to be removed surgically. The patient should be given specific treatment and supportive care if any further complications are experienced. A variety of treatment programmes are available like long-term rehabilitation coma treatment centers, behaviour management programmes, life-long residential or day treatment programmes and independent living programmes.

DoctorNDTV Team

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