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

Maxillofacial Trauma

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


References
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