Skull fractures are among the most severe injuries. Such violations of the integrity of the cranial bones occur after heavy 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 health of the patient. It is very important that first aid is provided in time for 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
Traumatic brain injuries are very common, especially at a young and middle age. They cause about half of 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. Many bones are connected by sutures, have a different structure and thickness. Some bones are pierced by blood vessels or have airways. Distinguish the facial and brain parts of the skull. It is in the brain that injuries most often occur.
Features of fractures of the cranial bones in that when impact of external damage may not be noticeable. After all, the cranial vault consists of internal and external plates, between which a spongy substance is located. The inner plate is very fragile, therefore, upon impact, it is damaged most often, even without violating 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 people of young and middle age, leading an active life or playing sports. As well as alcoholics, drug addicts and representatives of criminal structures. We can distinguish the following reasons for skull fractures:
- strong blows to the head with a hard object;
- falling from a height;
- car crashes;
- gunshot wound.
There are two mechanisms for obtaining such an injury: direct and indirect. When a bone breaks at the point of application of force - this is a direct fracture. This usually causes injuries to the cranial vault. Damaged bones are often pressed inward and damage the meninges. In an indirect fracture, the effect is transmitted from other bones. For example, when falling from a height on the pelvis or legs, a strong blow is transmitted through the spine to the base of the skull, often leading to its fracture.
Symptoms of Skull Fractures
The condition of the patient depends on how the first aid was correctly provided for a traumatic brain injury. With any strong blow to the head, you need to suspect the possibility of fracture of the bones of the skull. Indeed, sometimes such an injury is not accompanied by clearly visible symptoms. But there are special signs by which it is possible to 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 a swoon or a coma, memory loss, confusion of thoughts, hallucinations.
- In addition, skull fractures are always accompanied by severe headaches, dizziness, and nausea.
- With damage to the brain and nerve fibers, a violation of sensitivity, paresis and paralysis is observed.
- If a brain stem is affected by a fracture, breathing may be difficult, and blood circulation may be impaired.
- In fractures of the skull base, hematomas around the eyes or in the area of the mastoid process are often a characteristic symptom . There may be bleeding with impurities of the cerebrospinal fluid from the nose, ears.
- A very serious injury is a fracture of the temporal bone. It causes severe dizziness, impaired coordination of movements, nausea, hearing loss, paralysis of the facial nerve.
Classification of Skull Fractures
Injuries to the cranial bones can be different. They are classified by the nature of the fracture, the location, the severity of the lesion. Various parts of the skull may be affected. By 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;
- an impressed fracture also has serious consequences, because with it, the bones of the skull are pressed inward, which causes a brain crush;
- linear fractures are considered non-hazardous, since displacement of bone fragments does not occur, but they can cause damage to blood vessels and the appearance of hematomas;
- very rarely, a hole fracture occurs as a result of a gunshot wound, as a rule, such an injury is incompatible with life.
At the site of damage, a fracture of the temporal bone, occipital or frontal is distinguished. They relate to injuries of the cranial vault. If the base of the skull is damaged, it causes cracks in the facial bones, they extend to the orbits, nose bridge and even the ear canal. In addition, a fracture of the bones of the skull 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 the time of medical care.
Fracture of the cranial vault
Arises 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 often when hit, the inner plate of the cranial bone is damaged, which is almost not noticeable externally. The patient may even regain consciousness, but gradually the symptoms of brain damage will increase. Fracture of the cranial vault can occur for various reasons, most often - on impact. People with alcohol and drug intoxication are especially prone to such injuries. Indirect exposure, such as falling to the pelvis, may be accompanied by a fracture of the base of the skull. In this case, the patient's condition is especially serious, and the injury can result in death.
Fracture of the base of the skull
Survival for such injuries depends on timely medical care. Fracture in this place can be independent or accompany trauma of the cranial vault. In addition, a fracture of the anterior, middle and posterior cranial fossa is distinguished. Such injuries, depending on the place and severity, are accompanied by bleeding from the nose and ears, and 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 sensory organs suffer: eyesight, hearing, smell, and coordination of movements are impaired. A very serious injury is considered a fracture of the base of the skull. Her survival is about 50%.
Diagnosis of injuries
For any traumatic brain injury, an examination is performed to rule out a fracture. In addition to interviewing 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 the light are checked. An x-ray of the skull is also made in two projections. To confirm the diagnosis, the results of magnetic resonance imaging and computed tomography, puncture of the brain and echoencephalography are used. Such a study must be carried out even in the absence of visible consequences of the injury, since after an impact only the inner plate of the bones of the skull can be damaged.
Features of skull fractures in children
Despite the belief of many that the cranial bones in a child are stronger, such injuries often occur in babies. Moreover, their diagnosis is difficult, and the consequences are usually more serious. A fracture of the skull in a child is dangerous because immediately after the injury, the victim can feel good. This is due to 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. Multiple linear fissures, divergence of sutures and impression of bones are a feature of skull injuries in children. Less common than in adults, shrapnel fractures, hematomas and hemorrhages occur. But complications can be just as serious: epilepsy, hydrocephalus, developmental delay, visual and hearing impairment often develop.
First aid
When receiving a traumatic brain injury, it is very important how quickly medical assistance will be provided to the victim. 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, then he can lie on his back. When the victim faints, you need to turn on his side, fixing his head with pillows so that he does not choke with vomiting. It is advisable to remove all jewelry, glasses, dentures, unfasten clothing. The victim must be provided with free access to air.
If the injury on the head bleeds, a sterile dressing is applied to it, ice can be applied, but you can not touch or crush the site of damage. It is not recommended to give the patient any medicine before the doctor arrives, as, for example, narcotic analgesics can cause respiratory failure. As soon as possible, the victim must be taken to the doctor, even if he is conscious and feeling normal. After all, skull injuries never go unnoticed. And without timely treatment, they can cause serious consequences.
Features of the treatment of skull fractures
The 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 raised to reduce leakage of cerebrospinal fluid. In case of injury to the base of the skull, lumbar puncture or drainage is needed. With moderate and mild fractures, drug therapy is performed. The following drugs are prescribed to the patient:
- painkillers, non-steroidal anti-inflammatory;
- diuretics;
- antibiotics to exclude purulent infection;
- nootropic and vasotropic drugs;
- drugs to improve cerebral circulation.
If the fracture is severe, for example comminuted or depressed, with multiple damage to the bones, then surgical treatment is performed. It is needed to remove fragments and areas of necrotic tissue, as well as accumulated blood. During the operation, damage to nerves and blood vessels is also eliminated. Surgical treatment is used if purulent infection has begun, which cannot be eliminated with the help of conservative therapy.
Consequences of such injuries
If the skull fracture is linear, without displacement of bones and large hematomas, and also if purulent infection has been avoided, then the prognosis of cure is usually favorable. But a fracture of the skull is not always without complications. The consequences of such an injury can be very serious:
- meningitis, encephalitis;
- intracerebral hematomas can lead to encephalopathy;
- heavy bleeding most often ends in death;
- after a fragmented fracture of the base of the skull, paralysis of the whole body may develop;
- often patients suffer from psychological and emotional disturbances, decreased mental abilities.
Rehabilitation after skull fractures
With minor injuries, the patient's recovery is quick. Rehabilitation is mainly carried out at home and includes rest, walks in the fresh air, taking nootropic and sedative drugs, a special diet. More severe injuries rarely do without consequences. Rehabilitation of such patients is long, sometimes takes years. But still, many remain disabled and cannot return to their usual lives.