Management of bone fragments in nonmissile compound depressed skull fractures

AbdelFatah, Mohamed AbdelRahman

doi:10.1007/s00701-016-2976-0

Cited by 8 publications

(7 citation statements)

References 8 publications

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“…Eighteen articles were quantitatively analyzed following full-text analysis of the initial selected articles. These included 1 retrospective cohort study, 8 case series, and 9 case reports ( Table 1 ) [ 7 - 9 , 16 - 30 ] . Five studies were conducted in the United States, three in China, and one each in Brazil, Egypt, Germany, India, Indonesia, Japan, Nigeria, South Korea, Switzerland, and Turkey (10).…”

Section: Resultsmentioning

confidence: 99%

Outcomes of surgical management and implant consideration for depressed skull fractures: A systematic review

Nguyen¹,

Reddy²,

Sharaf³

et al. 2023

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Background: Traumatic brain injuries (TBIs) are associated with high mortality and morbidity. Depressed skull fractures (DSFs) are a subset of fractures characterized by either direct or indirect brain damage, compressing brain tissue. Recent advances in implant use during primary reconstruction surgeries have shown to be effective. In this systematic review, we assess differences in titanium mesh, polyetheretherketone (PEEK) implants, autologous pericranial grafts, and methyl methacrylate (PMMA) implants for DSF treatment. Methods: A literature search was conducted in PubMed, Scopus, and Web of Science from their inception to September 2022 to retrieve articles regarding the use of various implant materials for depressed skull fractures. Inclusion criteria included studies specifically describing implant type/material within treatment of depressed skull fractures, particularly during duraplasty. Exclusion criteria were studies reporting only non-primary data, those insufficiently disaggregated to extract implant type, those describing treatment of pathologies other than depressed skull fractures, and non-English or cadaveric studies. The Newcastle-Ottawa Scale was utilized to assess for presence of bias in included studies. Results: Following final study selection, 18 articles were included for quantitative and qualitative analysis. Of the 177 patients (152 males), mean age was 30.8 years with 82% implanted with autologous graft material, and 18% with non-autologous material. Data were pooled and analyzed with respect to the total patient set, and additionally stratified into those treated through autologous and non-autologous implant material. There were no differences between the two cohorts regarding mean time to encounter, pre-operative Glasgow coma scale (GCS), fracture location, length to cranioplasty, and complication rate. There were statistically significant differences in post-operative GCS (p < 0.0001), LOS (p = 0.0274), and minimum follow-up time (p = 0.000796). Conclusion: Differences in measurable post-operative outcomes between implant groups were largely minimal or none. Future research should aim to probe these basic results deeper with a larger, non-biased sample.

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Section: Resultsmentioning

confidence: 99%

Outcomes of surgical management and implant consideration for depressed skull fractures: A systematic review

Nguyen¹,

Reddy²,

Sharaf³

et al. 2023

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“…In the research performed by Wylen et al [11], no infection was detected in the study group consisting of 32 patients who underwent primary bone fragment replacement within the first 72 h after trauma. AbdelFatah [3] presented a study including 76 patients who underwent primary bone fragment replacement and found no infection in that series. In our study, infection was detected in only 2 of the 78 patients who were treated within the first 72 h after trauma.…”

Section: Discussionmentioning

confidence: 99%

“…In these patients, shortening the duration of contamination should be the main objective [5]. Although there are only a few studies in the literature showing that infection rates are high in operations performed with primary bone fragment replacement, in the last two decades, the rate of infection with primary bone fragment replacement has been found to be very low [3-5, 7, 9-11]. The infection rates are even lower, particularly in cases of intervention within the first 72 h after trauma.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Primary Bone Fragment Replacement in Pediatric Patients with Depressed Skull Fracture

et al. 2019

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Objective: To evaluate pediatric patients who were operated with the diagnosis of depressed skull fracture. Methods: The records of pediatric patients who presented with traumatic head injury to multicenter neurosurgery clinics between 2002 and 2018 and who were operated with a diagnosis of depressed skull fracture were retrospectively reviewed. All of the patients underwent primary bone fragment replacement operation, and the patients’ own bone flaps were used to repair depressed skull fractures in all of them. Results: A total of 78 patients were included in the study. Of the study group, 20 patients presented with mild head injury, 37 had moderate head injury, and 21 had severe head injury. Dural injury was present in 67 patients (86%) and the dura was intact in 11 patients (14%). After surgery, 63 patients (81%) had good outcome, 8 patients (10%) had moderate disability, and 5 patients (6.5%) had severe disability. Two patients with multiple accompanying cranial pathologies died and the mortality rate was 2.5%. Infection was detected in only 2 of the 78 patients who were treated within the first 72 h after trauma. One of them had meningitis and the other skin infection. Both patients were treated with appropriate antibiotherapy. None of the patients in the study group had an infection involving the bone, such as osteomyelitis, or the tissues under the bone, such as subdural-epidural empyema or abscess. None of the patients required reoperation and removal of the bone. Conclusion: In the present study, as the pathologies accompanying the depressed skull fractures of the patients increased, Glasgow Coma Scale scores at arrival and Glasgow Outcome Scale scores at discharge decreased. Regardless of whether the depressed fracture is simple or compound, primary bone fragment replacement with appropriate decontamination of the fractured bone and operation area via single-session intervention gives good results. It is important to perform the surgery as soon as possible to reduce the risk of contamination. Primary bone fragment replacement seems to be an appropriate treatment option for depressed skull fractures.

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“…A large proportion of respondents highlighted similar surgical indications, for both open and closed fractures, as those previously described in literature reviews. 2 3 Infection rates in open fractures can be as high as 40% 12 however more contemporary series' have reported rates ranging from 0% 13 to 17%. 14 Primary bone replacement instead of delayed cranioplasty was the option of choice among most respondents.…”

Section: Surgical Indicationsmentioning

confidence: 99%

Variations in the Neurosurgical Management of Depressed Skull Fractures in Adults: An International Cross-Sectional Survey

Suliman

Jayakumar

Chaurasia³

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Aims Depressed skull fractures have been well-described since antiquity, yet its management remains controversial. Contentious issues include the use of prophylactic antibiotics and antiepileptics, the role of non-operative management, and the replacement/removal of bone fragments. Our objective was to explore the management patterns of closed and open depressed skull fractures across the world. Material and Methods A 23-item, web-based survey was distributed electronically to the members of national neurosurgical associations, and on social media platforms. The survey was open for data collection from December 2020-April 2021. Statistical calculations were performed with SPSS v22 (IBM). Results A total of 218 respondents completed the survey, representing 56 countries. With regards to open fractures, most respondents (85.8%) treated less than 50 cases annually. Most respondents (79.4%) offered prophylactic antibiotics to all patients with open fractures, with significant geographical variation (p<0.001). Less than half (48.2%) offered prophylactic antiepileptics. Almost all (>90%) reported the following indications as important for surgical management: (1) grossly contaminated wound; (2) dural penetration; (3) depth of depression; and (4) underlying contusion/haematoma with mass effect. Most respondents treated less than 50 cases of closed depressed skull fractures annually. Most European respondents (81.7%) did not offer prophylactic antiepileptics in comparison to most Asian respondents (52.7%) (p<0.001). Depth of depression, an underlying haematoma/contusion with mass effect, and dural penetration were the most important surgical indications. Conclusions There remains a great degree of uncertainty in the management strategies employed across the world in treating depressed fractures, and future work should involve multi-national randomised trials.

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Management of bone fragments in nonmissile compound depressed skull fractures

Abstract: Primary bone fragment replacement (after decontamination) is a safe option in the management of nonmissile CDSF within 72 h of trauma in selected patients.

Cited by 8 publications

References 8 publications

Outcomes of surgical management and implant consideration for depressed skull fractures: A systematic review

Outcomes of surgical management and implant consideration for depressed skull fractures: A systematic review

Outcome of Primary Bone Fragment Replacement in Pediatric Patients with Depressed Skull Fracture

Variations in the Neurosurgical Management of Depressed Skull Fractures in Adults: An International Cross-Sectional Survey

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