The majority of skull fractures require no specific treatment because the break in the bone heals naturally with time. Treatment objectives are primarily for controlling pain, promoting healing, and preventing complications. The primary concern with a skull fracture is potential traumatic brain injury, for which treatment varies significantly based on the type of injury. (See Types of Head and Brain Injuries.)
Linear Skull Fracture
Most linear skull fractures do not require specific treatment. A simple, relatively straight-line crack is detectable in X-rays or CT scans and will eventually heal on its own.
If symptoms of bleeding inside the skull or an underlying brain injury are not present, the patient is typically treated for any external head wound and sent home with instructions to watch for late-developing signs that may indicate a brain injury. The patient should be cautious against any additional head trauma that can aggravate the injury. When no brain trauma is evident, a full recovery can be expected.
Basilar Skull Fracture
Due to its unique location, a linear skull fracture at the base of the skull can create complications. The break can sometimes extend into the sinus cavities and can also cause a tear in the membrane (the “dura”) surrounding the brain.
Because the dura surrounds the cerebrospinal fluid, in which the brain floats, a tear in it allows the fluid to leak out. This appears as a clear or pink-tinged fluid escaping from the nose or ears. A concern is that the tear in the dura may provide a path for infection. Some physicians may prescribe an antibiotic although many do not.
Sometimes bloody fluid leaking from the dura may collect under the skin around the eyes or behind the ears causing a bruised appearance. This is a sign of a more serious brain injury and is treated separately from the fracture.
The tear in the dura can seal itself in as little as 48 hours, but patients are often admitted to the hospital for a brief period. If leaking fluid persists, it may be necessary to implant a drainage tube to give the dura a better opportunity to heal. Lacking any sign of serious brain injury or later infection, recovery is usually uncomplicated.
Comminuted Skull Fracture
When the skull bone is broken into fragments, it’s referred to as a comminuted fracture, or a multi-fragmentary or radial fracture. Treatment is based on severity.
A simple comminuted fracture – with the bones remaining in alignment and not depressed – is itself not exceptionally serious. Similar to a linear fracture, the bone can be expected to heal without specific treatment. Because of the potentially fragile nature of the break, the patient should take precautions against any subsequent head trauma.
If bone fragments are dislodged, surgery may be required to align or remove fragments. If the bone has not penetrated the dura and there are no signs of injury beyond a possible concussion, a full recovery can be expected. However, concussion symptoms may persist for some months. (See Understanding Post-Concussion Syndrome.)
If the bone fragments are pushed inward, the injury is called a depressed skull fracture.
Depressed Skull Fracture
A head injury resulting in a noticeable depression in the skull is a depressed skull fracture. Treatment is often determined by the depth of the depression, whether it’s accompanied by an open wound, and the degree of accompanying brain trauma.
In the best case, the depression is not greater than the skull’s thickness and the skull is not exposed. Lacking any signs of brain damage requiring treatment, the fracture may not be treated and allowed to heal on its own, or for cosmetic reasons, it may be surgically elevated.
Deeper depressions and those with open wounds are frequently accompanied by damage to the brain. Surgery to elevate the bone and remove any fragments is often required. Surgery may also be needed to treat bleeding inside the skull. In these cases, mild to severe impairment and disability due to the brain injury can be expected.
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