Open skull fracture

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Open skull fracture

• - 2006-11-20 -
• Presented by Ri ???

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Skull fracture

• Linear, stellate , comminuted fracture
• Basillar fracture
• Depressed fracture
• Closed, open fracture

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Definition

• A skull fracture is open when a scalp laceration
  overlies a fracture.
• A fracture that disrupts the paranasal sinuses or
  the middle ear structures

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Surgical intervention or not?

• NEUROSURGERY
• Surgical Management of Depressed Cranial
  Fractures
• Volume 58(3) Supplement, March 2006, pp
  S2-56-S2-60
• (review of article-122 articles )
• The majority of studies are case series,
  retrospective,
• uncontrolled, nonrandomized studies.

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Indications

• Depressed greater than the thickness of the
  cranium should undergo operative intervention to
  prevent infection.
• Clinical or radiographic evidence of dural
  penetration, significant intracranial hematoma,
  depression greater than 1 cm, frontal sinus
  involvement, gross cosmetic deformity, wound
  infection, pneumocephalus, or gross wound
  contamination.
• Nonoperative management of closed (simple)
  depressed cranial fractures is a treatment option.

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Timing

• Early operation is recommended to reduce the
  incidence of infection.

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Methods

• Elevation and debridement is recommended as the
  surgical method of choice.
• Primary bone fragment replacement is a surgical
  option in the absence of wound infection at the
  time of surgery.
• All management strategies for open (compound)
  depressed fractures should include antibiotics.

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KEY ISSUES FOR FUTURE INVESTIGATION

• Well-controlled trials
• Examine issues of bone fragment replacement
  versus removal, dural laceration repair, etc., ?
  incidence of infection, epilepsy, need for
  reoperation, surgical complications, and
  neurological and neuropsychological outcomes.

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Thanks for your attention Ah