Depressed Skull Fractures

- Introduction

Head Trauma is a serious problem worldwide. Depressed skull fracture accounts for significant morbidity and mortality as it complicates the head injury in up to 6% subjects. Compound fractures account for up to 90%, the associated infection rate of DSF is 1.9 to 10.6%, an average neurological morbidity of approximately 11%, an incidence of late epilepsy of up to 15%, and a mortality rate of 1.4 to 19%.¹

Controversy surrounds appropriate management of depressed cranial fractures. The rationale for aggressive treatment of depressed cranial fractures stems from their association with infection and late epilepsy. Cosmetic deformity also plays a role in surgical decision making. Such complications, and their potential sequelae, are well documented.²

Another challenge to traditional thinking that has surfaced in the literature involves the proper surgical management of compound depressed cranial fractures with respect to the bone fragments. Conventional treatment involves operative debridement, elevation of the fracture, removal of bone fragments, and delayed cranioplasty. However, this subjects the patient to a second operation (i.e., cranioplasty), with its attendant risks and complications.^2,3