Skull Fractures

Written by Mary Ellen Ellis | Published on August 15, 2012
Medically Reviewed by George Krucik, MD

Skull Fracture Overview

A skull fracture is any break in the cranial bone, also known as the skull. There are many types of skull fractures, but only one cause: an impact or a blow to the head that is strong enough to break the bone. The fracture may be accompanied by injury to the brain, but that is not always the case.

A fracture is not always easy to see. However, symptoms that can indicate a fracture include:

  • swelling and tenderness around the impact area
  • facial bruising
  • bleeding from the nose and ears

Treatment depends on the severity of the fracture. Pain medication may be the only treatment necessary in mild fractures, while surgery may be required for more serious injuries.

Types of Skull Fractures

The type of skull fracture depends on the force of the blow, the location on the skull at which the impact occurs, and the shape of the object making impact with the head. A pointier object is more likely to penetrate the skull than a flat object, such as the ground or another hard surface. Different types of fractures lead to differing levels of injury and trauma.

Closed Fracture

A closed fracture, also called a simple fracture, is one in which the skin is not broken or cut.

Open Fracture

Also known as a compound fracture, an open fracture is one in which the skin is broken and the bone emerges from it.

Depressed Fracture

This refers to a fracture that causes the skull to be depressed or to extend into the brain cavity.

Basal Fracture

A basal fracture occurs in the floor of the skull. This is any area around the eyes, ears, nose, or back, near the spine.

In addition to the above types, fractures can further be classified as linear (in a straight line), greenstick (incomplete), or comminuted (broken into three or more sections).

Causes of Skull Fractures

A skull fracture occurs when a force is applied that is strong enough to break the bone. Any type of impact to the head can cause a skull fracture, including being hit with an object, falling and hitting the ground, head injury in a car accident, or any other type of trauma.

Symptoms of Skull Fractures

In some cases, as in an open or depressed fracture, it may be easy to see that the skull is broken. Sometimes, though, the fracture is not obvious. Serious symptoms of a skull fracture include:

  • bleeding from the wound caused by the trauma, near the location of the trauma, or around the eyes, ears, and nose
  • bruising around the trauma area, under the eyes, or behind the ears
  • pain at the site of the trauma
  • swelling at the injured area
  • redness or warmth at the trauma site

Less severe symptoms, or those that may not necessarily appear to be related to a skull fracture, may include:

  • headache
  • nausea
  • vomiting
  • blurred vision
  • restlessness
  • irritability
  • trouble balancing
  • a stiff neck
  • pupils not reacting to light
  • confusion
  • drowsiness
  • fainting

Diagnosis of Skull Fractures

A doctor may be able to diagnose a fracture by simply performing a physical examination of the head. However, it is useful to diagnose the extent and exact nature of the damage, which requires more exact diagnostic tools.

Various imaging techniques can be used to get a clearer picture of what kind of fracture has occurred and how far it extends. X-rays and magnetic resonance imaging (MRIs) are typical methods for imaging the body and can be used to diagnose skull fractures. X-rays penetrate soft tissues and give an image of the bone. An MRI produces an image of the bone and soft tissue, allowing a doctor to see both the skull fracture and the brain.

The most common tool used, however, is a CT or CAT scan, also known as a computed tomography scan. This technique usually gives the clearest picture of the fracture and any damage to the brain because it produces a three-dimensional image.

Treatment of Skull Fractures

Treatment for a skull fracture depends on several factors. A doctor will take into consideration the patient’s age, health, and medical history as well as the type of fracture, its severity, and any resulting brain injuries.

In some cases, such as in basal skull fractures, medication to control pain may be all that is needed. The skull will heal itself in these instances. However, a basal fracture may require surgery if it results in excessive leakage of cerebrospinal fluid from the nose and ears.

Surgery is more often a required course of treatment for depressed skull fractures. If the depression is severe enough, surgery may be needed to correct it. Surgery may also be performed if the depression is putting pressure on the brain or if there is cerebrospinal fluid leakage.

Prevention of Skull Fractures

Skull fractures can often be prevented. Wearing protective headgear when riding bicycles or participating in other sports in which head injuries are possible, such as football and rock climbing, can prevent a skull fracture.

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