CASE 1597 Published on 31.07.2002
0

Depressed skull fracture

Section

Paediatric radiology

Case Type

Clinical Cases

Authors

J. Johnston, A. Paterson, CS McKinstry

Connected authors
Annie Paterson UNITED KINGDOM
Patient

9 months, female

Categories
No Area of Interest ; Imaging Technique CT
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Clinical History
The patient fell downstairs and landed on her head.
Imaging Findings
The patient fell downstairs and landed on her head. She was brought to the Accident and Emergency Department immediately by her parents. Clinical examination revealed a palpable depression in the skull vault beneath the child's wooden hair bobble. Skull radiographs and a CT scan of the brain were performed.
Discussion
Skull fractures in children are relatively common and approximately 25% are depressed. The parietal bone is the most common site, and neonatal birth trauma, road traffic accidents and direct blows to the head are the commonest causes of depressed fractures. A case series from Philadelphia described injuries similar to those seen in this case in children wearing hair beads.

Complications of head injuries in children may occur with or without an associated skull fracture. They include dural tears, cerebral damage, and subdural and extradural haematomas. Extracerebral haematomas are rare with depressed fractures. A growing skull fracture or leptomeningeal cyst is a rare complication that follows a dural tear in early childhood.

Following a depressed fracture, a skull radiograph will demonstrate an increased density where one border of the fracture fragment overlies the adjacent bone. A tangential view will reveal the fragment lying deep to the skull vault. A CT scan of the brain is indicated in patients with depressed skull fractures to evaluate the underlying cerebrum and to show the fracture fragments more clearly in prospective surgical candidates.

Surgical elevation of the bony fragments is the usual treatment for depressed skull fractures when the depth of depression is more than the full thickness of the adjacent skull vault. Surgery is also indicated when there is a dural tear or for cosmesis in older children.

Differential Diagnosis List
Depressed skull fracture
Final Diagnosis
Depressed skull fracture
Case information
URL: https://www.eurorad.org/case/1597
DOI: 10.1594/EURORAD/CASE.1597
ISSN: 1563-4086
Figure 1

Skull radiograph

Skull radiograph
Lateral skull radiograph showing the increased density associated with the overlapping bone fragments of the depressed left parietal fracture.
Skull radiograph
Coned PA skull radiograph showing the fracture fragments lying deep to the skull vault.
Figure 2

CT of the brain

CT of the brain
CT of the brain (soft tissue windows) just inferior to the site of the fracture. There is a small bubble of intracranial air, consistent with the presence of a dural tear. There is distortion and displacement of the underlying cerebral cortex.
CT of the brain
CT of the brain (bone windows) demonstrating the depressed fracture fragments.