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Depressed Skull Fracture

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This is the same 9-year-old patient

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who I demonstrated previously,

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who had the posterior fossa hemorrhage.

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However,

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I want to look at the bone windows to show you

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the calvarial changes in this individual.

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So, as you can see,

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this patient has soft tissue swelling,

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as well as some air in the subcutaneous tissue,

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likely from a laceration or puncture wound.

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However, you'll also note, as I scroll,

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that the patient has a small area of dark signal intensity

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along the calvarium,

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representing pneumocephalus.

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Let me demonstrate that.

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So this is the area of the pneumocephalus demonstrated,

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and you can see the soft tissue swelling

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with the air more superficially.

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What I want to point out, however, is this area here

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where the patient has a calvarial fracture.

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Let's scroll through that.

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As we move through, you can see that,

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in point of fact, this is a comminuted fracture.

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There's a portion here more posteriorly and a portion

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here more anteriorly.

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You'll note that this fracture,

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although depressed,

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is not depressed by greater than one calvarial thickness.

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It's only about, let's say, 25% to 30%.

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And therefore, this in and of itself,

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were it not for the open wound,

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which we demonstrated shortly,

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would not be treated surgically.

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You'll notice, however,

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that the patient does have another fracture on

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the contralateral side.

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This one as well is nondisplaced

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and would not otherwise be treated surgically.

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As we scroll further inferiorly,

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we see that the degree of the displacement of the anterior

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portion of this fracture is increasing over

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the course of inferior scrolling.

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And eventually, you see that we have this comminuted

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area with air adjacent to the fracture,

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and then some fracture fragments

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that are depressed greater than

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one skull thickness deep,

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and these would have to be treated neurosurgically.

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This is the same patient before who had that fracture

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through the mastoid portion of the temporal bone

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with extension to the middle ear cavity.

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So, again,

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the indications for surgery include an open fracture,

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which is communicating with the outer surface of the skin,

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leading to the high rate of possible meningitis,

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as well as the degree of depression

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greater than one skull thickness deep.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Trauma

Skull Base

Neuroradiology

Musculoskeletal (MSK)

Interventional

Infectious

Head and Neck

Emergency

CT

Brain

Bone & Soft Tissues

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