classify fractures by pattern
- linear
- diastatic
- depressed
- comminuted
calssify fractures by location
- convexity
- base
classify fractures by skin integrity
- closed
- open
mx of linear fracture
- Conservative: observation, neurologic monitoring. * Repeat imaging if symptoms develop.
- unless open or large hematoma is present (debridement/crainotomy)
mx of diastatic fracture
- Conservative: observation, neurologic monitoring. * Repeat imaging if symptoms develop.
- unless open or large hematoma is present (debridement/crainotomy)
mx of depressed skull fracture
Surgical elevation if:
* open (within 6 hrs)
* Depression > 1cm skull thickness,
* epidural hematoma >1.5 cm, subdural hematoma >1 cm
* midline shift +0.5 cm
* detoriorating GCS +2
* GCS < + dilated pupil
* Neurological deficit, CSF leak, contamination, dural tear, or cosmetic deformity.
*
Antibiotics if open.
Anticonvulsants if cortical injury.
- elective cosmetic
mx of Comminuted Skull Fracture
- Closed: observation ± surgery if depressed or hematoma.
- Open/compound: surgical = debridement. + antibiotics.
- large bone loss or contamination = Reconstruction surgery
CT findings of an acute epidural hematoma
- biconvex hyperdense lesion
- at the left/right ……….. region
prietal/temporal/frontal/occipital
case
indication of CT
GCS below 15
approach or mx of a pt who’d fallen from height
- ABCDE
- send pt for a CT scan
- defenitive mx accordingly
airway/breathing/circulation/disability/exposure
mx of epidural hematoma
Surgical elevation if:
* open (within 6 hrs)
* >1.5 cm
* midline shift +0.5 cm
* detoriorating GCS
* Neurological deficit, CSF leak, contamination, dural tear, or cosmetic deformity.
* Depression > 1cm skull thickness,
Antibiotics if open.
Anticonvulsants if cortical injury.
mx of subdural hematoma
+indications of surgery
Conservative if small and asymptomatic
Surgical if large hematoma, symptomatic or open. = craniotomy or temporary burr holes if neurosurgical delay.
—-
Indications
Surgical elevation if:
* open (within 6 hrs)
* >1 cm
* midline shift +0.5 cm
* detoriorating GCS
* Neurological deficit, CSF leak, contamination, dural tear, or cosmetic deformity.
* Depression > 1cm skull thickness,
Antibiotics if open.
Anticonvulsants if cortical injury.
anterior skull base fracture findings
- raccoon eyes
- CSF rhinorrhea
- anosmia
middle skull base fracture findings
- battle sign
- hemotympanum
- otorrhagia
- csf otorrhoea
- 7 + 8 CN palsey (bell + deaf)
