Highlights & Basics
- Skull fractures commonly result from a fall, a traffic accident, or an assault.
- Skull fractures may be linear or comminuted with multiple fracture lines, may be located on the cranial vault or in the basilar skull, may have a varying degree of depression or elevation, and can be open or closed. Open fractures communicate with the skin through a wound, a sinus, the ear, or the oropharynx.
- Computed tomography, with thin axial cuts, remains the imaging modality of choice. With basilar skull fractures, 3D reconstructions are useful.
- May be associated with other significant injuries, most importantly intracranial hemorrhage.
- For isolated skull fractures, treatment is primarily conservative.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Linear parietal fracture without depression
Axial CT scan demonstrating an open nondepressed linear skull fracture (arrow) associated with pneumocephalus (circle)
Axial CT scan showing nondepressed linear skull fracture (arrow) of the skull base involving the foramen magnum. This injury pattern is concerning for associated spinal fracture, cord injury, and blunt cerebrovascular injury
Comminuted nondepressed fracture
Comminuted depressed skull fracture with pneumocephalus
Comminuted depressed fracture of the frontal sinus with air, fluid, and bone fragments in frontal sinus and pneumocephalus; level of depression greater than width of cortex
Depressed skull fracture: level of depression equal to thickness of cortex
Axial CT scan demonstrating open elevated linear skull fracture (large arrow). Note the air in the soft tissues (small arrow), the small amount of pneumocephalus associated with the fracture (circle), and that the level of elevation of the bone fragment is significantly more than the thickness of the bony table
Sagittal CT images of an open, comminuted, depressed skull fracture. Note the associated pneumocephalus (small arrows). The level of depression is greater than the bony table and there are a number of bone fragments impacted below the inner cortex of the opposing bone (large arrow). Despite lack of underlying associated brain injury this fracture required operative debridement and elevation of the bone fragments. See also the corresponding coronal CT image
Coronal CT of an open, comminuted, depressed skull fracture. The level of depression is greater than the bony table and there are a number of bone fragments impacted below the inner cortex of the opposing bone (large arrow). Despite lack of underlying associated brain injury this fracture required operative debridement and elevation of the bone fragments. See also the corresponding sagittal CT image
Fracture of temporal bone
Fracture of temporal bone extending into foramen ovale
Occipital fracture extending to foramen magnum: risk of brainstem compression by hematoma
Transcranial gunshot wound
Gunshot wound with comminuted elevated fracture and pneumocephalus
Gunshot wound with perpendicular blowout fracture
Citations
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