Interactive Transcript
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Another indication for surgical intervention
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is on the basis of a skull fracture.
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It is said that patients who have open skull
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fractures are generally treated surgically.
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This is because open skull fractures lead from the outside
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to the intracranial contents where there is CSF,
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and that puts the patient at increased risk of meningitis.
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So for these patients,
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often, the surgeons will intervene early.
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The other determination about whether or not a patient
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will be operated on for skull fracture is related
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to the degree of depression of the fracture.
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So if we have a portion of the fracture,
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which is depressed by less than one
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full thickness of the bone,
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those patients are often observed and don't
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have intervention.
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On the other hand,
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if you have a fracture which is depressed greater
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than one full thickness of the skull,
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those patients get intervention early.
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So, more than one full thickness of the skull depression
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is one of the indications for surgical intervention.
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However, a closed fracture that is not open to the air,
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not open to the outside world,
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that is less than one full thickness depressed,
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may be observed over the course of time.
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Here are a couple of examples of fractures,
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and I show these as two different cases.
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The one above versus the one below.
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As we can see by the case above,
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you have a laceration through the skin surface and that
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is communicating with the intracranial content.
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So this is what we would call an open fracture and this is
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one that they would intervene early in order
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to prevent the possibility of meningitis.
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The example below is a patient who has a depressed skull
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fracture and we note that it is depressed inward by
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greater than one full thickness of the adjacent temporal bone.
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And therefore, because of this degree of depression,
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this patient also would have intervention for
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correction of the depressed skull fracture.
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Interestingly enough,
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you'll note that despite that great depression of the
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fracture, you don't see intraparenchymal hemorrhage.
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Usually there is some element of subarachnoid hemorrhage
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due to some venous bleeding in the subarachnoid space,
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but at least in this case,
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you don't see anything in the brain parenchyma per se.
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It's true that in children who have more flexible
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calvarium than adult calvarium, you often will see that
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they don't have adjacent brain tissue damage as opposed to in
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the adult where you usually will see something
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underlying the fracture.
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Remember that these are both coup injuries,
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so do not forget to look across the aisle here,
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bipartisan,
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and see whether or not there is an injury
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to the adjacent contrecoup location.
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