Skull Fractures

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 major cause: an impact or a blow to the head that’s strong enough to break the bone. An injury to the brain can also accompany the fracture, but that’s not always the case.

A fracture isn’t always easy to see. However, symptoms that can indicate a fracture include:

  • swelling and tenderness around the area of impact
  • facial bruising
  • bleeding from the nostrils or ears

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

Types of Skull Fractures

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

Closed Fracture

With a closed fracture, also called a simple fracture, the skin that covers the fracture area isn’t broken or cut.

Open Fracture

Also known as a compound fracture, an open fracture occurs when the skin is broken and the bone emerges.

Depressed Fracture

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

Basal Fracture

A basal fracture occurs in the floor of the skull: the areas around the eyes, ears, nose, or back, near the spine.

In addition to the above types, fractures can also classify as: 

  • linear (in a straight line)
  • greenstick (incomplete)
  • comminuted (broken into three or more sections)

Causes of Skull Fractures

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

Symptoms of Skull Fractures

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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 isn’t 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 site, under the eyes, or behind the ears
  • severe pain at the trauma site
  • swelling at the trauma site
  • 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
  • loss of balance
  • stiff neck
  • pupils not reacting to light
  • confusion
  • excessive drowsiness
  • fainting

Diagnosis of Skull Fractures

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

Doctors can use various imaging techniques to get a clearer picture of the kind of fracture you have and how far it extends. X-rays and magnetic resonance imaging (MRIs) are typical methods for imaging the body and can help to diagnose skull fractures. An X-ray penetrates soft tissue and provides 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 is a computerized tomography scan (CT or CAT scan. This technique usually provides the clearest picture of the fracture and any damage to the brain because it produces a 3-D image.

Treatment of Skull Fractures

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Treatment for a skull fracture depends on several factors. A doctor will take into consideration the person’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 the patient needs. The skull will heal itself in a majority of 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 necessary to correct it. Surgery may also be necessary if the depression puts 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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