Monitoring
Patients with skull fracture should be followed up at regular intervals, about every 2 to 3 months initially, to assess for continued neurological symptoms, and to monitor for evidence of late-onset seizures. Patients should also be followed up to monitor for resolution of cranial nerve injury. If symptoms are persistent, delayed surgical decompression may be required.
Patients at particularly high infectious risk should also receive laboratory testing including FBC and repeat imaging to rule out intracranial infection; this includes patients with fractures involving the frontal or maxillary sinus, or after repair of fractures with metallic hardware, as an abscess or mucopyocele is possible.[97]
Children, especially if aged <3 years, should be assessed every 2 months to exclude a growing skull fracture or a secondary craniosynostosis. This should take the form of a clinical assessment with head circumference measurement and head shape documentation (ideally with medical photography). Repeat imaging should be performed if there is suspicion of growing skull fracture or a secondary craniosynostosis. However, routine repeated imaging is not recommended owing to radiation exposure.
Grossly contaminated open skull fractures should be followed up in 2 to 3 months with computed tomography (CT) scans to rule out an intracranial abscess.[5][55][74]
Consider referring patients who have persisting problems to a clinician trained in assessing and managing the consequences of traumatic brain injury (e.g., a neurologist, neuropsychologist, clinical psychologist, neurosurgeon or endocrinologist, or a multidisciplinary neurorehabilitation team).[28]
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