Skull fractures are among the most severe injuries. Such violations of the integrity of the cranial bones occur after strong blows to the head and are often accompanied by brain damage. Therefore, these injuries are life-threatening. And even with a favorable outcome, they have serious consequences for the he alth of the patient. It is very important that first aid is provided in time for a traumatic brain injury. This will help prevent death. But in any case, the treatment of such injuries is very long and requires complex rehabilitation.
Features of skull fractures
Tranio-cerebral injuries are very common, especially in young and middle age. They cause about half of the deaths among all injuries. This is due to the fact that a violation of the integrity of the cranial bones often leads to compression or damage to the brain and blood vessels. In addition, the skull has a very complex structure. Lots of bonesconnected by seams, have a different structure and thickness. Some bones are permeated with blood vessels or have air cavities. There are facial and cerebral parts of the skull. It is in the brain that most injuries occur.
Features of fractures of the cranial bones is that when struck, external damage may not be noticeable. After all, the cranial vault consists of the inner and outer plates, between which there is a spongy substance. The inner plate is very fragile, so it is most likely to be damaged on impact, even without breaking the integrity of the outer plate.
Causes of such injuries
Skull fractures result from the application of great force. They are most often exposed to young and middle-aged people who lead an active life or go in for sports. As well as alcoholics, drug addicts and representatives of criminal structures. There are such reasons why skull fractures occur:
- strong blows to the head with a hard object;
- falling from a height;
- car accidents;
- gunshot wound.
There are two mechanisms for obtaining such an injury: direct and indirect. When a bone breaks at the point where force is applied, it is a direct fracture. So usually there are injuries of the cranial vault. Damaged bones are often pressed inward and damage the meninges. In an indirect fracture, the impact is transmitted from other bones. For example, when falling from a height onto the pelvis or legs, a strong blow is transmitted through the spine to the base of the skull, often leading to itsfracture.
Symptoms of skull fractures
The further condition of the patient depends on how correctly first aid was provided for a traumatic brain injury. With any strong blow to the head, the possibility of a skull fracture should be suspected. Indeed, sometimes such an injury is not accompanied by well-visible symptoms. But there are also special signs by which one can determine not only the presence of a fracture, but sometimes the place of its localization and damage to the meninges.
- The main symptom of a skull fracture is impaired consciousness. It can be fainting or coma, memory loss, confusion, hallucinations.
- In addition, skull fractures are always accompanied by severe headaches, dizziness, nausea.
- When the brain and nerve fibers are damaged, there is a violation of sensitivity, paresis and paralysis.
- If the brainstem is affected as a result of a fracture, breathing may be difficult, blood circulation may be impaired.
- In case of a fracture of the base of the skull, hematomas around the eyes or in the area of the mastoid process are often a characteristic symptom. There may be bleeding with impurities of cerebrospinal fluid from the nose, ears.
- A fracture of the temporal bone is considered a very serious injury. It causes severe dizziness, incoordination, nausea, hearing loss, facial paralysis.
Classification of skull fractures
Injuries to the cranial bones can be different. They are classified according to the nature of the fracture, location, severity.defeat. Various parts of the skull may be affected. According to the nature of the injury, three types are distinguished:
- the most severe is a comminuted fracture, as a result of which the meninges and blood vessels can be damaged;
- a depressed fracture also has serious consequences, because with it the bones of the skull are pressed inward, which causes crushing of the brain;
- linear fractures are considered harmless as no displacement of bone fragments occurs, but they can cause vascular damage and bruising;
- very rare also is a perforated fracture resulting from a gunshot wound, as a rule, such an injury is incompatible with life.
According to the place of damage, a fracture of the temporal bone, occipital or frontal is distinguished. They refer to injuries of the cranial vault. If the base of the skull is damaged, this causes cracks in the facial bones, they extend to the eye sockets, bridge of the nose, and even the ear canal. In addition, a skull fracture can be open or closed, single or multiple. The patient's condition depends on the severity of the injury, the degree of damage to the meninges and blood vessels, as well as on timely medical care.
Fractured calvaria
Occurs from a blow to the scalp. Therefore, the main symptom of such an injury is a wound or hematoma in this place. But the difficulty in diagnosing this injury is that the inner plate of the cranial bone is often damaged upon impact, which is almost invisible from the outside. The patient may even come toconsciousness, but gradually the symptoms of brain damage will increase. A skull fracture can occur for a variety of reasons, most commonly on impact. People under the influence of alcohol and drugs are especially susceptible to such injuries. Indirect impact, such as a fall on the pelvis, may be accompanied by a fracture of the base of the skull. In this case, the patient's condition is especially severe, and the injury can be fatal.
Fracture of the base of the skull
Survival from such injuries depends on timely medical care. A fracture in this place may be independent or accompany an injury to the cranial vault. In addition, there is a fracture of the anterior, middle and posterior cranial fossa. Such injuries, depending on the location and severity, are accompanied by bleeding from the nose and ears, the expiration of cerebrospinal fluid. A characteristic symptom of a fracture of the anterior cranial fossa is bruising around the eyes. With such injuries, all the patient's senses suffer: vision, hearing, smell, coordination of movements are impaired. A fracture of the base of the skull is considered a very serious injury. Its survival rate is approximately 50%.
Injury diagnosis
Any traumatic brain injury is examined to rule out a fracture. In addition to questioning the victim or his companions about the circumstances of the injury, the doctor examines the patient. Sensitivity, the presence of reflexes are assessed, the pulse and the reaction of the pupils to light are checked. An x-ray of the skull is also taken in two projections. For confirmationdiagnosis, the results of magnetic resonance and computed tomography, brain puncture and echoencephalography are used. Such a study must be carried out even in the absence of visible consequences of the injury, since only the inner plate of the skull bones can be damaged after a blow.
Features of skull fractures in children
Despite the belief of many that the cranial bones of a child are stronger, such injuries often occur in babies. Moreover, their diagnosis is difficult, and the consequences are usually more serious. A skull fracture in a child is dangerous because immediately after the injury, the victim may feel well. This is due to the insufficient development of the frontal lobes and other parts of the brain. The consequences appear later: a strong increase in pressure, loss of consciousness, vomiting, anxiety, tearfulness. A feature of skull injuries in children are multiple linear cracks, divergence of sutures and depression of bones. Less often than in adults, fragmental fractures, hematomas and hemorrhages occur. But complications can be just as serious: epilepsy, hydrocephalus, developmental delays, visual and hearing impairments are common.
First aid
When receiving a traumatic brain injury, it is very important how quickly the victim will receive medical assistance. Often his life depends on it. Until the victim is taken to the hospital, he must be laid on a hard surface without a pillow, fixing his head with soft objects. If he is conscious, thencan lie on his back. In case of fainting, the victim must be turned on his side, fixing his head with pillows so that he does not choke when he vomits. It is advisable to remove all jewelry, glasses, dentures, unbutton clothes. The victim must be provided with free access to air.
If an injury to the head bleeds, a sterile bandage is applied to it, ice can be applied, but you can not touch or put pressure on the injury. It is not recommended to give the patient any medication before the arrival of the doctor, since, for example, narcotic analgesics can cause respiratory failure. As soon as possible, the victim should be taken to a doctor, even if he is conscious and feels normal. After all, skull injuries never go unnoticed. And without timely treatment, they can cause serious consequences.
Features of the treatment of skull fractures
A victim with a traumatic brain injury should be in the hospital. Depending on the severity and location of the injury, conservative or surgical treatment may be prescribed. Be sure to comply with bed rest. The head should be slightly elevated to reduce the flow of cerebrospinal fluid. In case of skull base injury, a lumbar puncture or drainage is needed. For fractures of moderate and mild severity, drug therapy is performed. The patient is prescribed the following drugs:
- painkillers, non-steroidal anti-inflammatory drugs;
- diuretics;
- antibiotics to exclude purulent infection;
- nootropic and vasotropic drugs;
- drugs to improve braincirculation.
If the fracture is severe, such as comminuted or depressed, with multiple bone damage, then surgical treatment is performed. It is necessary to remove fragments and areas of necrotic tissue, as well as accumulated blood. During the operation, damage to the nerves and blood vessels is also eliminated. Surgical treatment is used if a purulent infection has begun, which is not eliminated with the help of conservative therapy.
The consequences of such injuries
If the skull fracture is linear, without bone displacement and large hematomas, and if purulent infection has been avoided, then the prognosis for recovery is usually favorable. But not always without complications passes a skull fracture. The consequences of such an injury can be very serious:
- meningitis, encephalitis;
- intracerebral hematomas can lead to encephalopathy;
- excessive bleeding most often ends in death;
- after a fragmentation fracture of the base of the skull, paralysis of the entire body may develop;
- often patients suffer from psychological and emotional disorders, mental decline.
Rehabilitation after skull fractures
With minor injuries, the recovery of the patient is fast. Rehabilitation is mainly carried out at home and includes rest, walks in the fresh air, taking nootropic and sedative drugs, and a special diet. More severe injuries are rarely without consequences. The rehabilitation of such patients is long, sometimes taking years. But still, many remain disabled and cannot return tohabitual life.
