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Skull Fractures

 

Key points

  1. There are different types of skull fractures, with each type depending on factors such as the force of the blow and the location of the impact.
  2. In some cases, an injury to the brain can also accompany the fracture.
  3. Symptoms of a skull fracture include swelling around the area of impact, facial bruising, and bleeding from the nostrils or ears.

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.

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Types

Types of skull fractures

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, blunt surface, such as the ground. Different types of fractures lead to differing levels of injury and trauma. See a body map of the skull.

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 facture

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 at the top of the neck, near the spine.

Other types

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

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

Causes

Causes of skull fractures

A skull fracture occurs when a force that’s strong enough to break the bone hits the skull. Any type of impact to the head can cause a skull fracture. This includes being hit with an object, falling and hitting the ground, injuring the head in a car accident, or any other type of trauma. Get medical attention if you have any head injury symptoms.

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Symptoms

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 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 in a condition known as raccoon eyes, or behind the ears as in a Battle’s sign
  • 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:

Diagnosis

Diagnosing skull fractures

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. This requires more specific diagnostic tools.

Doctors can use various imaging tests to get a clearer picture of the kind of fracture you have and how far it extends. X-rays, CTs, and MRIs are typical methods for imaging the body and can help your doctor diagnose skull fractures.

An X-ray provides an image of the bone. An MRI takes an image of the bone and soft tissue. This allows your doctor to see both the skull fracture and the brain.

The most common tool used is a CT or CAT scan. This test usually provides the clearest picture of the fracture and any damage to the brain because it produces a 3-D image.

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Treatment

Treating skull fractures

Skull fractures aren’t managed exactly like other bone fractures. Treatment will depend on several factors. Your doctor will take into consideration your age, health, and medical history, as well as the type of fracture, its severity, and any resulting brain injuries.

Most skull fractures aren’t too painful, and the skull will heal itself in a majority of these instances. In some cases, such as in basal skull fractures, medication to manage pain may be all that’s needed. Although narcotics may sometimes be necessary, most people with a skull fracture only need over-the-counter medications such as acetaminophen (Tylenol) for a short course.

However, a basal fracture may require surgery if it results in excessive leakage of cerebrospinal fluid (the liquid that cushions and surrounds the brain and spinal cord) from the nose and ears.

Surgery is more often a required course of treatment for depressed skull fractures if the depression is severe enough. This is because depressed skull fractures have a harder time healing on their own.

Depressed skull fractures could result in not only cosmetic issues, but also potential for further injury to the brain if the fracture isn’t corrected. Surgery may also be necessary if the depression puts pressure on the brain or if there’s cerebrospinal fluid leakage.

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Outlook

Outlook for skull fractures

Overall, most skull fractures heal on their own and don’t need surgery as long as there aren’t associated injuries to other structures such as the brain. They heal over time, usually over six weeks.

However, in certain circumstances as described above, there are features about the fracture itself or associated injuries that may require surgery to make sure they heal.

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Prevention

Preventing 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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