Escolar Documentos
Profissional Documentos
Cultura Documentos
Classification
Fractures
- > 3mm in width - Widest at center, narrow at ends - Darker on x-ray (entire thickness)
Sutures
- < 2mm in width - Same width throughout - Lighter on x-ray
Presentation
Mostly asymptomatic if important structures are not involved. May have swelling at the site of impact.
Presentation
Presentation depends on the bone fractured. Battles sign, ecchymosis of the mastoid process, indicating fracture of middle cranial fossa and possible underlying brain damage. Raccoons eyes, periorbital ecchymosis associated with frontal basal fracture. CSF rhinorrhea CSF otorhea Bleeding from nose or ears Cranial nerve palsy
Presentation
Epidural hematoma Dural tears Seizures Loss of consciousness
Investigation
CT scan is the standard modality for aiding diagnosis. X-ray is of no benefit if CT scan is obtained. MRI is useful only for ligamentous and vascular injuries. When there is bleeding and suspected CSF leak, when dabbed on a tissue paper, shows a clear ring of wet tissue beyond the blood stain, called a halo sign. Neurological examination, baseline lab analysis and tetanus toxoid (in case of open fractures)
Management
Adults with simple linear fractures who are neurologically intact do not require any intervention and may be discharged and asked to return if symptomatic. Neurologically intact patients with linear basilar fractures are treated conservatively without antibiotics. Surgery usually indicated to elevate depressed fragments more than 5mm below the inner table of adjacent bone.