A skull fracture is a type of injury that is most frequently caused by some type of physical trauma. There are many different types of incidents that may result in a skull fracture along with other accompanying injuries. Because the fracture usually takes place under the skin and can vary from minor to severe, it is not always possible to know right away if an individual's skull has been fractured. It is important to seek medical attention immediately if one suspects their skull or a loved one's skull is fractured as it is a medical emergency.
Definition & Facts
According to the Centers for Disease Control and Prevention, an estimated 1.7 million cases of traumatic brain injury occur each year. This is relevant because skull fractures can cause short-term or long-term injury to the brain. Up to half of all traumatic brain injuries, including those involving skull fractures, will result in death within the first 120 minutes following the injury. An estimated 5.3 million people in the United States are now coping with long-term disabilities related to traumatic brain injuries.
Skull fractures are predominantly seen in men (78.8 percent of cases). It is thought this is because more males participate in contact sports, though car crashes are also a significant cause of skull fractures. There are several different types of skull fractures. They include:
- Closed (simple) fracture. This simplest fracture type will not puncture the surrounding skin.
- Open (compound) fracture. Often the skin is broken to the point where bone can be seen.
- Depressed skull fracture. The skull may be indented (concave) to the point where it actually enters the brain area.
- Basilar skull fracture. This fracture type affects the base of the skull which is the area that is adjacent to the facial structures of the nose, eyes, and ears.
- Skull fractures can also be linear (straight), greenstick (not complete) or comminuted (in sections).
Symptoms & Complaints
- Double vision or "foggy" vision.
- Sleepiness and fatigue.
- Trouble sleeping.
- Vertigo or dizziness.
- Memory problems and concentration issues.
- Light sensitivity and noise sensitivity.
If the skull fracture is more severe or it has been allowed to progress without treatment, symptoms of brain injury may worsen correspondingly to include these:
- Dilated pupils.
- Neck stiffness
- Blurred vision and slurred speech.
- Extreme irritability or other inappropriate responses.
- Clumsy movements, lack of coordination, convulsions.
- Low blood pressure
- Clear or blood draining from sinuses, mouth and/or ears.
- Bruising or swelling to the face/injury site.
- Poor hearing, loss of taste, loss of smell (anosmia).
- Losing consciousness or coma.
- Paralysis of limbs.
If these symptoms temporarily resolve, emergency medical attention should still be sought. Additionally, fractures can puncture the brain when a piece of bone affected by the fracture gets displaced. This can cause a related condition called a hematoma (brain bleeding) that can lead to clotting and a disabling or even fatal brain aneurysm.
It is particularly common to see skull fractures in contact sports such as football or soccer. Sports most closely associated with skull fractures include:
- Bike riding.
Auto accidents and falls can also cause skull fractures. Violent physical assaults are an additional source of these fractures.
Diagnosis & Tests
Achieving the proper diagnosis quickly is critical when treating a skull fracture. The longer diagnosis and treatment is delayed, the more serious the potential long-term effects may become. If possible, all exams begin with a medical history and recounting of events that took place to cause the injury to the skull area. From here, it is necessary to go into more depth to determine the exact nature and extent of the injury itself.
Diagnosis involves determining what the nature of the injury to the skull area is and if the skull fracture is simple, compound, basilar, or depressed. To diagnose the type and extent of the skull fracture, physicians will use a variety of diagnostic tools as may best fit the individual's specific injury:
- CT (computed tomography) scan. This is most commonly used because it can produce a 3-D image of the brain and fracture area.
- X-ray. An x-ray can capture images of the bone to show the nature and extent of the fracture.
- MRI (magnetic resonance imaging). An MRI will give the diagnosing physician an image of both the bone and soft tissue affected by the injury.
Treatment & Therapy
Treating a skull fracture begins with first aid, in which breathing and pulse are confirmed and CPR (cardiopulmonary resuscitation) is performed if necessary. It is imperative to call 911. The person with the suspected skull fracture should not be moved, but if it is necessary, the head and neck must be stabilized. Bleeding should be addressed with a bandage or sterile cloth, and the person administering first aid should use pressure when trying to stop the bleeding.
The type of treatment will depend on the type of skull fracture. Some skull fractures do not require treatment and heal on their own. Open, depressed skull fractures usually require surgery, as do most skull fractures in which the brain itself is injured and swollen. In such cases, a craniectomy may be performed to remove a part of the skull in order to relieve the pressure and swelling in the brain. Cranioplasty is a surgery to repair the skull which utilizes bone grafting.
Ossiculoplasty is another surgery that may be performed in the aftermath of a skull fracture. It is a procedure that repairs or reconstructs the bones within the ear that may be damaged as a result of the skull fracture or the fracture's underlying cause.
In addition, open skull fractures can easily become infected and therefore may require antibiotics. Long-term therapies may be needed if the trauma has caused any cognitive impairment, loss of mobility, or memory loss. Such therapies and rehabilitation could take the form of physical therapy, occupational therapy, and psychotherapy, among others.
Prevention & Prophylaxis
Taking precautions to reduce the risk of automobile accidents is paramount in preventing brain injuries and skull fractures. Choosing a vehicle with high safety ratings, always wearing one's seat belt, and practicing safe driving techniques are important. It is also crucial to never drink and drive and never get in the car with a drunk driver.
Bicyclists can reduce their risk of head injuries by obeying traffic laws and wearing lights and helmets. Bicyclists must remain vigilant and aware of their surroundings, however, as cycling remains dangerous in many cities in America.