How to Treat a Skull Fracture

A skull fracture is any break in a skull bone and can be caused by as little as five foot pounds of force. It usually occurs from a direct impact. There are four major types of skull fractures: basilar, depressed, diastatic and linear. The skull is susceptible to damage as it is relatively heavy and in an unstable position.

Difficulty: Challenging

Instructions

1. Discharge adult patients with simple linear fractures, if they are neurologically intact, with instructions to return if they become symptomatic. Infants are usually observed overnight.

2. Provide conservative treatment for most patients with linear basilar fractures without neurological deficit because the tympanic membrane usually heals without surgery. This also includes most patients with types II and III occipital fractures.

3. Prescribe anti-seizure medication if seizures seem likely based on the clinical evaluation and radiographic images. Open contaminated fractures also may require antibiotics and a tetanus vaccination.

4. Perform surgery for open depressed fractures. Closed depressed fractures also may require surgery if the depression is more than 5 mm. Elevate the bony fragments and repair any tears in the dura. Soak the bony fragments in an antibiotic and saline solution.

5. Reassemble the skull fragments using wire for the larger pieces. Cover larger defects with titanium mesh. Methyl methacrylate can be used to replace missing fragments in adults but generally should be avoided in children. Postoperative epidural collection may be prevented with complete hemostasis.

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