Skull fractures

The prognosis of patients with skull fracture is primarily determined by the prognosis generated from associated intracranial and cervical spinal injuries.[61]Bonfield CM, Naran S, Adetayo OA, et al. Pediatric skull fractures: the need for surgical intervention, characteristics, complications, and outcomes. J Neurosurg Pediatr. 2014 Aug;14(2):205-11. http://www.ncbi.nlm.nih.gov/pubmed/24905840?tool=bestpractice.com Overall mortality ranges from 1.4% to 19% and is almost always due to associated intracranial injuries.[62]Demetriades D, Charalambides D, Lakhoo M, et al. Role of prophylactic antibiotics in open and basilar fractures of the skull: a randomized study. Injury. 1992;23(6):377-80. http://www.ncbi.nlm.nih.gov/pubmed/1428162?tool=bestpractice.com [64]Rehman L, Ghani E, Hussain A, et al. Infection in compound depressed fracture of the skull. J Coll Physicians Surg Pak. 2007 Mar;17(3):140-3. http://www.ncbi.nlm.nih.gov/pubmed/17374298?tool=bestpractice.com [71]Bullock MR, Chesnut R, Ghajar J, et al; Surgical Management of Traumatic Brain Injury Author Group. Surgical management of depressed cranial fractures. Neurosurgery. 2006 Mar;58(3 suppl):S56-60. http://www.ncbi.nlm.nih.gov/pubmed/16540744?tool=bestpractice.com Neurologic complications occur in 11% of cases.[71]Bullock MR, Chesnut R, Ghajar J, et al; Surgical Management of Traumatic Brain Injury Author Group. Surgical management of depressed cranial fractures. Neurosurgery. 2006 Mar;58(3 suppl):S56-60. http://www.ncbi.nlm.nih.gov/pubmed/16540744?tool=bestpractice.com If no associated intracranial or cervical spinal injuries are present, the outcome is excellent. Poor prognostic factors include an open fracture, pupillary changes and a Glasgow Coma Scale <8 at presentation, and advanced age.