Skull fractures may occur with head injuries. Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull. It may be accompanied by injury to the brain.
The brain can be affected directly by damage to the nervous system tissue and bleeding. The brain can also be affected indirectly by blood clots that form under the skull and then compress the underlying brain tissue (subdural or epidural hematoma).
A simple fracture is a break in the bone without damage to the skin.
A linear skull fracture is a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone.
A depressed skull fracture is a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brain.
A compound fracture involves a break in, or loss of, skin and splintering of the bone.
Note: The only symptom may be a bump on the head. A bump or bruise may take up to 24 hours to develop.
1. Check the airways, breathing, and circulation. If necessary, begin rescue breathing and CPR.
2. Avoid moving the victim (unless absolutely necessary) until medical help arrives. Instruct someone to call 911 (or the local emergency number) for medical assistance.
3. If the victim must be moved, take care to stabilize the head and neck. Place your hands on both sides of the head and under the shoulders. Do not allow the head to bend forward or backward, or to twist or turn.
4. Carefully check the site of injury, but do not probe in or around the site with a foreign object. It can be difficult to know if the skull is fractured or depressed (dented in) at the site of injury.
5. If there is bleeding, apply firm pressure with a clean cloth to control blood loss over a broad area.
6. If blood soaks through, do not remove the original cloth. Instead, apply additional cloths on top, and continue to apply pressure.
7. If the victim is vomiting, stabilize the head and neck (as outlined in number 3, above), and carefully turn the victim to the side to prevent choking on vomit.
8. If the victim is conscious and experiencing any of the previously listed symptoms, transport to the nearest emergency medical facility (even if the patient does not think medical assistance is necessary).
1. Use car seats or seat belts whenever in a motor vehicle.
2. Use helmets whenever biking, skating, skiing, climbing, or playing contact sports.
3. Use equipment designed specifically for the type of sport or recreation in which you are participating.
4. Provide appropriate supervision for children of any age.
5. Do not allow children to bike or skate at night.
6. Provide and wear highly visible clothing.
7. Teach children to obey traffic rules and signals.
8. Educate individuals about risks of various work, recreational, or sport activities and how to avoid injury.
9. Report any concerns you might have about abuse.
Basilar skull fracture; Depressed skull fracture; Linear skull fracture
Biros MH, Heegaard WE. Head injury. In: Marx JA, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 38.
Leveque JC, Hoff JT. Neurosurgery. In: Greenfield LJ, Mulholland MW, Oldham KT, Zelenock GB, Lillemoe KD, eds. Greenfield's Surgery: Scientific Principles and Practice. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2005:chap 114.
Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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