Predicting Dural Tear in Compound Depressed Skull Fractures: A Prospective Multicenter Correlational Study

Salia, Shemsedin Musefa; Mersha, Hagos Biluts; Aklilu, Abenezer Tirsit; Baleh, Abat Sahlu; Lund‐Johansen, Morten

doi:10.1016/j.wneu.2018.03.095

Cited by 13 publications

(5 citation statements)

References 10 publications

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“…4 Nevertheless, this model is not well standardized and generates results with substantial variability regarding histopathological, biochemical, and functional outcomes. [7][8][9][10][11]15,28,[36][37][38] Our results demonstrated that animals experiencing skull fractures after undergoing the WD model show a substantial inflammatory response in the brain, while animals without skull fractures do not, thus demonstrating how skull fractures contribute to the heterogeneity of the WD model.…”

Section: Discussionmentioning

confidence: 77%

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Skull Fractures Induce Neuroinflammation and Worsen Outcomes after Closed Head Injury in Mice

Zvejniece

Stelfa

Vāvers

et al. 2020

Journal of Neurotrauma

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The weight-drop model is used widely to replicate closed-head injuries in mice; however, the histopathological and functional outcomes may vary significantly between laboratories. Because skull fractures are reported to occur in this model, we aimed to evaluate whether these breaks may influence the variability of the weight-drop (WD) model. Male Swiss Webster mice underwent WD injury with either a 2 or 5 mm cone tip, and behavior was assessed at 2 h and 24 h thereafter using the neurological severity score. The expression of interleukin (IL)-6, IL-1b, tumor necrosis factor-a, matrix metalloproteinase-9, and tissue inhibitor of metalloproteinase-1 genes was measured at 12 h and 1, 3, and 14 days after injury. Before the injury, micro-computed tomography (micro-CT) was performed to quantify skull thickness at the impact site. With a conventional tip diameter of 2 mm, 33% of mice showed fractures of the parietal bone; the 5 mm tip produced only 10% fractures. Compared with mice without fractures, mice with fractures had a severity-dependent worse functional outcome and a more pronounced upregulation of inflammatory genes in the brain. Older mice were associated with thicker parietal bones and were less prone to skull fractures. In addition, mice that underwent traumatic brain injury (TBI) with skull fracture had macroscopic brain damage because of skull depression. Skull fractures explain a considerable proportion of the variability observed in the WD model in mice-i.e., mice with skull fractures have a much stronger inflammatory response than do mice without fractures. Using older mice with thicker skull bones and an impact cone with a larger diameter reduces the rate of skull fractures and the variability in this very useful closed-head TBI model.

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Section: Discussionmentioning

confidence: 77%

“…36 Approximately one-half of depressed skull fractures in patients with TBI result in dural tearing, which is associated with cranial infections. 37,38 In patients, skull fracture with hemorrhage results in increased inflammation and neuronal excitability because of the…”

Section: Discussionmentioning

confidence: 99%

Skull Fractures Induce Neuroinflammation and Worsen Outcomes after Closed Head Injury in Mice

Zvejniece

Stelfa

Vāvers

et al. 2020

Journal of Neurotrauma

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“…In another study from Addis Ababa, Salia and colleagues reported dural tears in more than half of DSF patients. 40 The high rate of postoperative CSF leak in our study was therefore probably related to difficulty of attaining a water tight closure of the dural defect (e.g. glue or dural substitues were not available).…”

Section: Discussionmentioning

confidence: 75%

Prospective Study of Surgery for Traumatic Brain Injury in Addis Ababa, Ethiopia: Surgical Procedures, Complications, and Postoperative Outcomes

et al. 2021

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“…According to one study, pneumocephalus, cerebral contusion, and depth of depression were the most predictive parameters for dural tears in patients with DSFs 22 , 23 . In our study, contusions and EDHs were predictive of dural tears.…”

Section: Discussionmentioning

confidence: 99%

Magnitude of dural tear and its associated factors among patients with depressed skull fracture

Molla,

Alemu,

Kassa

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction: Trauma is a huge problem seen in developed countries as well as developing countries. Head injury is a major factor responsible for mortality in young populations. Up to 6% of all head injuries and 11% of severe head traumas might result in a depressed skull fracture (DSF), a catastrophic injury. The aim of this study was to determine the prevalence of dural tear and to identify its predictors.. Method: A retrospective review of medical records of all patients operated on for depressed skull fractures at the University Comprehensive Specialized Hospital from January 1, 2021, to January 1, 2023 G.C. was conducted. A total of 163 patients were included in the study. Results: A total of 163 patients (136 men (83.4%) and 27 women (16.6%) had a mean age of 23.9 with a standard deviation of 14.8 (range from 3-65). Patients with penetrating injuries (missiles, axes) were excluded. The majority, 153 (93.9%) of the patients, were younger than 50 years of age. Physical assault accounted for 102 (62.5%) of the cases. Of the assaulted cases, 62 (38%) were assaulted by stone, 32 (19.6%) by stick, and 8 (5%) by other objects (beer bottle and shovel). Bleeding from the trauma site in 124 (76.1%), headache in 76 (46.6%), loss of consciousness in 75 (46%), and vomiting in 72 (44.2%) were the most common presentations. Based on the Glasgow Coma Scale (GCS), 123 (75%) of patients had mild head injuries. Based on the site of fracture, frontal depressions are the most common (61, 37.4%), followed by parietal depressions (53, 32.5%). With regard to the associated injuries, brain contusion was seen in 52 (32%), epidural hematoma in 26 (16%), subdural hematoma in 3 (1.8%), and IVH/SAH in 3 (1.8%). The median duration of presentation was 15 hours, with an IQR of 8–24 (1–96 hours). From the multivariable logistic regression, brain contusion and epidural hematoma were significantly associated with dural tear. Conclusion: The rules of our culture are reflected in the higher incidence of accidents and fractures among men. Physical assault, particularly with stones, was the most common cause of DSFs. Frontal depressions were the most common site of fracture, followed by parietal fractures. Brain contusion and epidural hematoma were significantly associated with dural tears. School-aged children are more vulnerable to injuries from horse or donkey kicks and falls.

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Predicting Dural Tear in Compound Depressed Skull Fractures: A Prospective Multicenter Correlational Study

Cited by 13 publications

References 10 publications

Skull Fractures Induce Neuroinflammation and Worsen Outcomes after Closed Head Injury in Mice

Skull Fractures Induce Neuroinflammation and Worsen Outcomes after Closed Head Injury in Mice

Prospective Study of Surgery for Traumatic Brain Injury in Addis Ababa, Ethiopia: Surgical Procedures, Complications, and Postoperative Outcomes

Magnitude of dural tear and its associated factors among patients with depressed skull fracture

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