The unique layered architecture of these bones enhances the skull's strength. ĪNATOMY AND MECHANISM OF INJURY - The skull is made up of the frontal, ethmoid, sphenoid, and occipital bones, two parietal bones, and two temporal bones ( figure 1 and figure 2 and figure 3). The most common causes of head injury in adults include:Īlthough skull fractures themselves may or may not indicate the presence of significant TBI, certain skull fracture types, such as depressed skull fractures, basilar skull fractures with associated cerebral spinal fluid (CSF) leak, and fractures of the temporal-parietal bone that traverse the middle meningeal artery and vein, are associated with significant morbidity and mortality. According to another retrospective study of 2254 cases of head trauma from assault, approximately one-third sustained a skull fracture. Īccording to one retrospective study of 207 head-injured patients, 37 percent of those with associated intracranial pathology sustained a linear skull fracture. Each year, approximately 2.8 million people sustain head injuries in the United States alone, resulting in approximately 2.5 million emergency evaluations, 300,000 hospital admissions, and 60,000 deaths. Much of the data on skull fractures in adults come from studies of traumatic brain injury (TBI). (See 'Definition and presentation of skull fracture types' below.) Linear fractures are the most common, followed by depressed and basilar skull fractures. The parietal bone is most frequently fractured, followed by the temporal, occipital, and frontal bones. (See "Skull fractures in children: Clinical manifestations, diagnosis, and management" and "Intracranial epidural hematoma in adults" and "Subdural hematoma in adults: Etiology, clinical features, and diagnosis" and "Nonaneurysmal subarachnoid hemorrhage" and "Acute mild traumatic brain injury (concussion) in adults".)ĮPIDEMIOLOGY - The incidence of skull fractures among head injured adults who present to emergency departments (ED) is unknown. Skull fractures in children and intracranial injuries are discussed separately. The epidemiology, mechanisms, clinical presentation, associated complications, and initial management of skull fractures in adults are reviewed here. Significant skull fractures are often accompanied by moderate or severe intracranial injury and extracranial injuries associated with high-energy trauma, such as cervical and other spine fractures and thoracoabdominal injuries. They occur when forces striking the head exceed the mechanical integrity of the calvarium. INTRODUCTION - Skull fractures have plagued humankind throughout history.
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