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Images

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8

Skull fractures

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

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18

Skull fractures

Selection of children for CT head scan; GCS = Glasgow Coma Scale; CT = computed tomography; A&E = accident and emergency department

Adapted from Rajesh S et al. BMJ 2023;381:p1130

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1

Skull fractures

Linear parietal fracture without depression

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11

Skull fractures

Fracture of temporal bone

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14

Skull fractures

Transcranial gunshot wound

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19

Skull fractures

Battle's sign: superficial ecchymosis over the mastoid process

Gert W van Dijk Pract Neurol 2011;11:50-55.

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16

Skull fractures

Gunshot wound with perpendicular blowout fracture

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9

Skull fractures

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

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7

Skull fractures

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

From the teaching collection of Demetrios Demetriades; used with permission

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15

Skull fractures

Gunshot wound with comminuted elevated fracture and pneumocephalus

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13

Skull fractures

Occipital fracture extending to foramen magnum: risk of brainstem compression by haematoma

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3

Skull fractures

Axial CT scan showing non-depressed 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

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6

Skull fractures

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

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10

Skull fractures

Depressed skull fracture: level of depression equal to thickness of cortex

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12

Skull fractures

Fracture of temporal bone extending into foramen ovale

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17

Skull fractures

Selection of adults for CT head scan; GCS = Glasgow Coma Scale; CT = computed tomography; A&E = accident and emergency department

Adapted from Rajesh S et al. BMJ 2023;381:p1130

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2

Skull fractures

Axial CT scan demonstrating an open non-depressed linear skull fracture (arrow) associated with pneumocephalus (circle)

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5

Skull fractures

Comminuted depressed skull fracture with pneumocephalus

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4

Skull fractures

Comminuted non-depressed fracture

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