0:01

I want to reuse this case in order to demonstrate

0:05

the description that one would have for the

0:08

fractures and the posterior fossa mass effect.

0:12

So this case shows a comminuted fracture

0:16

of the occipital bone with portions of the

0:20

fracture fragments that are depressed inward,

0:23

greater than one thickness of the calvarium.

0:28

And not only that, but we see that there

0:30

is air that is present in the posterior

0:35

fossa associated with the fracture.

0:37

Now, if this fracture is not communicating with the

0:42

mastoid air cells of the temporal bone, then the

0:45

likelihood is that this air occurs secondary to a

0:49

communication with the skin surface from the trauma

0:54

and therefore would be considered an open fracture.

0:57

So the presence of air intracranially without an

1:00

explanation from the paranasal sinuses, mastoid

1:02

air cells, or middle ear cavity would suggest

1:05

that it is communicating with the outside world

1:07

and therefore potentially an open fracture.

1:10

Those two would be the indications for

1:13

surgical correction of the fractures,

1:18

in this case, in the occipital bone.

1:20

In this patient who had the epidural hematoma

1:25

associated with transverse sinus fracture,

1:26

they're going to do surgery to repair the sinus.

1:31

And as I said, this is difficult surgery

1:33

because the risk is that the sinus may

1:36

thrombose and lead to a venous infarction.

1:39

Once again, you see the air in the hematoma

1:42

associated with this fracture and epidural hematoma

1:47

in the posterior fossa.

1:49

If you see effacement of the basal cisterns or

1:53

midline shift of the fourth ventricle, which is

1:56

mild in this case, it may also be an indication for

2:00

surgical intervention in the posterior fossa trauma.

Case: Occipital Bone Open/Depressed Fracture on CT

HIDE

Prev Next

Interactive Transcript

Pro Tip: Click on a word in the transcript to jump to that point in the video