Surgical Management and Outcome of Depressed Skull Fracture

Objective: To know the surgical management and outcome of depressed skull fracture.Materials and Methods: This descriptive study was conducted in Head injury unit Hayatabad Medical Complex, Peshawar from October 2006 to October 2009. Detail history regarding the cause of depressed skull fracture, duration since injury, clinical condition, and CT Scan picture were documented in a Performa. Depressed fracture of more than 5 mm, cosmetically disfiguring fractures and fracture over the sinuses were operated. All the patients were given prophylactic antibiotics and anticonvulsants. These patients were followed up for six months. History of fits, clinical examination of the wound, CSF leak and neurological assessment of patients were done on every visit. The data was analyzed in SPSS 16.Results: This study includes 48 consecutive, surgically treated, depressed skull fractures patients. Male-to-female ratio was 2.2 : 1. The age range of the patients was 1-63 years with a mean age of 14.1 years. The pediatric population constituted the largest group 26 (54.1%) with the 16-30 year-old age group the next largest 12 (25.0%). 10 (20.8%) patients were older than 30 years. Etiological factors include fall from height in 26 (54.16%) cases, road traffic accident in 15 (31.25%), recreational activities injury in 1 (2.08%), physical violence in 3 (6.25%) and miscellaneous in 3 (6.25%) cases. 35 (72.91%) patients presented with mild head injury, 7 (14.58%) had moderate head injury and 6 (12.5%) with severe head injury. Closed depressed skull fracture was noted in 11 (22.91%) cases, while compound depressed skull fracture was in 37 (71.09%) cases. The incidence of depressed skull fracture was 8 (16.67%) in frontal bone, 8 (16.67%) in fronto-parietal, 10 (20.8%) in temporal, 13 (27.08%) in parietal, 5 (10.41%) in occipital, 2 (4.17%) on superior saggital sinus, 1 (2.08%) on confluence of sinuses and 1 (2.08%) on transverse sinus. Associated intracranial lesions were Extradural hematoma 16 (33.3%) Contusions 15 (31.25%), Dural tear 23 (47.92%) and in driven bone fragment 7 (14.58%). Postoperatively, 35 (72.9%) patients showed excellent recovery, 6 (12.5%) were hamiparetic, 4 (8.33%) were having seizures and 2 (4.17%) remained in vegetative state, and 3 (6.25%) developed meningitis. 2 (4.17%) patients had surgical site wound infections. 1 patient developed pseudomeningocele. One patient had CSF leak.Conclusion: Depressed skull fractures are common in children. Anticonvulsants and antibiotics are effective in prevention of epilepsy and infection during perioperative period. Early surgical treatment is extremely desirable when fracture is more than 5 mm depressed and open depressed skull fractures. The outcome of depressed skull fracture depends on severity of injury and presence of other associated intracranial lesion