Management of simple depressed skull fractures in children

Abstract

Surgical elevation is the treatment usually recommended for a simple depressed skull fracture if the depression is more than the full thickness of the adjacent skull, but there is no clinical evidence to support this management. On that basis, a progressively more conservative approach to the treatment of this condition was adopted, especially in young children. Experience with this mode of management over the period 1972 to 1984 is presented. Of 111 patients under 16 years of age with depressed skull fractures, 64 had simple and 47 compound fractures. Simple depressed skull fractures occurred in a younger age group after less significant trauma than compound fractures. In those patients who were treated surgically, there was an 11% incidence of dural laceration in patients with simple depressed fractures versus 67% for the patients with compound depressed fractures. There was no difference in outcome between surgically and nonsurgically treated patients with simple depressed fractures with respect to the occurrence of seizures, neurological dysfunction, or cosmetic appearance. Surgical treatment prolonged hospitalization, and the only case with a fatal outcome was found in the group of patients treated surgically. It is suggested that the standard treatment of simple depressed skull fractures in the pediatric age group should not include surgery. Surgery is indicated when there is definite evidence of dural penetration and in the older child with an unacceptable cosmetic appearance.

Pediatric skull fractures: the need for surgical intervention, characteristics, complications, and outcomes

“…As in our series, there is a male predominance in most reports on skull fracture. 1,3,9,10,16 The most common cause of injury varies among reports, but mainly lists MVCs, 1,10,15 falls, 3,9,13 and assaults 16 as the predominant mechanisms. However, many of these studies do not differentiate between the age of the patients or those who received surgical treatment for the fracture.…”

“…5,15 Pediatric skull fractures remain distinct from their adult counterparts. Pediatric skull fractures have a greater capacity to heal and remodel, but the pediatric brain and craniofacial skeleton are also still developing, which puts the children at risk for unique complications, such as growing skull fractures.…”

Elevation of Depressed Skull Fracture with a Cup of Breast Pump and a Suction Generator : A Case Report in Technical Aspects

“…Depressed skull fractures may not only interrupt the growth and function of the brain but also give rise to an epileptogenic focus or other signs of dysfunction 4,14) . Therefore, early treatment is needed.…”

“…Hung et al 4) have also stated that vacuum extraction is another treatment option for larger and deeper depressions to attain prompt recovery from a defect at the acute stage without additional risks. Steinbok Paul et al 14) have advocated that there is no difference in treatment outcomes between surgically and nonsurgically treated patients with simple depressed fractures, and that the standard treatment of simple depressed skull fractures in the pediatric age group without any definite evidence of dural penetration should not include surgery. There have been a few reports on spontaneous reduction without any surgical and nonsurgical elevation 6,7,8,10) .…”

“…Operative interventions have been recommended for simple depressed skull fractures for the following reasons : cosmetic results, possible underlying pathogical features, the prevention of seizures, and the improvement of focal neurological signs 2,3,9) . However, nonsurgical modalities, including digital pressure, the use of a breast pump, and the use of an obsterical vaccum extractor, have been successfully used in the treatment of several reported cases 1,4,14) . The authors report a case of depressed skull fracture elevated by means of a cup of breast pump and a suction generator.…”