Primary reconstruction of depressed skull fracture — The changing scenario

Abstract

Approximately 25% of all skull fractures are compound and merit immediate attention. Inadvertently fracture segments are removed in emergency to worsen the cosmetic problem. To analyze the benefit of primary reconstruction of depressed fracture and compare the various options available today. Thirty two patients underwent primary fracture reconstruction, from a study period of Feb2005 to Nov 2007 were analyzed retrospectively. The various techniques adopted by the author like simple elevation, apposition by nylon suture; or rigid fixation by titanium and absorbable mini plate were undertaken. Twenty two patients were male and ten were female. Eighteen (56%) cases underwent titanium miniplate fixation and eleven (34%) apposition using nylon sutures. In two cases simple elevation of fracture segments was carried out and in one fixation with absorbable (Poly-L- lactide) miniplate, was performed. Infection and Plate rejection were not encountered in this study. Cosmetic deformity correction to acceptable level was achieved better with miniplate. Primary reconstruction of fracture segment should be attempted as and when possible. Even in India, titanium mini plate is cost effective and better option to any other available measures.

“Bone-mesh”: Combined fractured bone and titanium mesh for primary reconstruction of compound skull fractures

“…The standard approach towards compound skull fractures of removal of bone followed by re-construction in a second stage has given way to a single staged procedure of debridement and repair in one go. This practice of single staged procedure is only restricted to patients with early presentation, 3,4 in this study the mean interval between injury and operation was 62 h, yet there were no detrimental outcomes in relation to wound infections in this group of patients. The major clinical concern for early single stage cranioplasty is infection: wound infection, brain abscess, meningitis and osteomyelitis.…”

“…12 The conventional methods of stabilizing bone fragments include threads, wires and plates. Titanium has also served this role both as a stabilizing system when used as miniplates 4 and as a substitute to bone when titanium mesh is used to fill the defect. 4,10 But the use of both bone fragments and mesh as has been done in our study is a new technique and this solves a multitude of functions.…”

“…Further rigid fixation was done to achieve good cosmetic results. 4 Bone-Mesh was used preferentially to only bone and miniplate-screw, to improve cosmetic result (Fig 3), for better strength of the construct when the patient may need early use of the part of the calvarium when recumbent (Fig 2). It also confers better alignment of bone fragments during fixation, gives better results from the puzzle created by multiple bone fragments ( Fig 1).…”

Open Comminuted Expressed - Depressed Skull Fracture

“…In addition, care should be taken of the preservation of scalp vascularization during the surgical preparation. By closing the dura with plasticization by means of prepared periosteum, potential development of meningitis, cerebral abscess and pseudomeningocele formation is prevented, which is mentioned as the main goal of surgery in literature (9). Then, the planned reconstruction of the cranial defect was performed.…”

“…Free fragments were used for the partial reconstruction of the frontal squama and the superciliary arch. According to literature data (9), reconstruction by means of cranial bone grafts, the so-called 'titanium mesh', especially for frontal-orbital region, remains the method of choice. The advantage of using synthetic materials such as Polyhydroxyethyl methacrylate is the ade quate correction of frontal orbital defects (10), and main disadvantages include the possibility of infection, potential development of fistula, graft migration, as well as formation of granuloma and erosion.…”