Linear fracture of the cranial vault. Fracture of the skull bones, consequences, signs, assistance

It should be noted that it is also quite dangerous. The skull bone is considered one of the strongest in human body. However, 10 percent of all fractures occur in this part of the body. Such damage can occur with very strong physical impact on the head. For example, during:

• car accident;
• collision with a vehicle;
• falls;
• fights;
• blow to the head.

The most common head injuries

When a head injury occurs, the following types of disorders occur:

• damage to the surface of the head;
• injury;
• skull fracture.

There are no specific symptoms that differentiate a head contusion from a fracture. It is impossible to diagnose the nature of the injury on your own. If you suspect even minor damage head, you must go to the hospital. There are traumatic brain injuries that are initially asymptomatic and then lead to irreversible consequences, up to fatal outcome.

Types of skull fractures

All skull fractures are divided into:

• base fracture;
• vault fracture.

In the second option, the bone, brain and its membranes are damaged. A fracture of the base of the skull is usually characterized by cracks that extend to the area of ​​the nose, eyes and may affect the ear canal.

All damage also varies in nature:

• Shrapnel - with such an injury, bone particles are formed that damage the brain, its membranes, arteries and blood vessels. The prognosis for this fracture is unfavorable.
• Depressed - the skull bone is displaced into the brain, damaging its structure. Also destroyed internal vessels, which leads to extremely sad consequences.
• Linear - considered the least dangerous type of fracture. The cranial bones do not move, and therefore the integrity and structure of the brain are not damaged. However, with this fracture there is a risk of damage to the arteries, which subsequently form hematomas.

Symptoms of a skull fracture

After a strong blow to the head, a bruise, bone damage, or a fracture of the base of the skull may occur. Symptoms directly depend on the form and severity of the injury. However, there are some manifestations that may indicate a fracture of the base of the skull:

• vomit;
• bright bruises under the eyes;
• the pupils do not respond to stimuli or are of different sizes;
• excessive movements or complete paralysis;
• blurred vision;
• Very severe pain in my head.

There are some signs that are characteristic of certain type damage is:

• Fracture of the base of the skull - usually affects visual system and sense of smell. The brain connects to the nasal and ocular canals, after which they penetrate various infections, which cause the most dangerous diseases. If this type of fracture is also a fragmentation one, then there is a risk of damage to the arteries, which leads to hemorrhages and hematomas.
• In case of violation of the rear cranial fossa the presence of bruises in the ear area is detected. The facial and ear nerves. Paralysis of the tongue or larynx is possible. In especially severe cases, internal organs are damaged.
• For a fracture of the middle cranial fossa frequent symptoms are ear bleeding. There is a rupture of the eardrum. Bruising may occur in the temple or ear area. This injury is the most common type of skull fracture.
• Symptoms of damage to the anterior fossa include nosebleeds or discharge of cerebrospinal fluid from the nose. In addition, such an injury is characterized by the appearance of bruises in the eye area.

What does a linear, depressed, comminuted, basal skull fracture look like? The photos fully prove the seriousness of such a dangerous condition.

Diagnostics

In the event of a skull injury, timely diagnosis can save lives. The patient, who is conscious, is initially given a visual examination. The doctor asks about the circumstances of the injury, writes down symptoms, and carefully examines the injured area. In addition, the specialist conducts neurological examination, checks the reaction of the pupils, various reflexes, measures blood pressure. After which, to confirm the diagnosis, a instrumental examination using x-rays.

Pictures are taken in two projections. Additional MRI or SCT procedures are often prescribed. What threatens a person who has been diagnosed with a basal skull fracture? Consequences. The patient’s lifestyle after such an injury can change dramatically, and not in better side. The doctor briefs the patient and prescribes treatment. If the patient is unconscious, the diagnosis is made only by visual inspection. If the outcome is successful, it is later confirmed with the help of additional examinations.

What to do in case of a fracture?

Treatment for a skull fracture may vary from case to case, depending on the severity of the injury. There are two types of treatment for such fractures:

• conservative;
• surgical

The first type of treatment is used in mild cases, and sometimes in moderate ones. Conservative treatment:

• shake;
• injury;
• closed fracture of the base of the skull.

Always assigned bed rest and complete calm. The duration depends on the severity of the condition. Various anti-inflammatory drugs, antibiotics and nootropics are also used.

As a rule, after minor injuries occurs full recovery. The situation takes a little longer if it is a fracture of the base of the skull. The consequences are different. For some, complete recovery occurs, for others, the injury leads to disability.
Fractures such as comminuted and depressed fractures require immediate surgical intervention. The doctor removes fragments from the cranial cavity and foreign objects. Damage to blood vessels and arteries poses a particular danger. They lead to the formation of hematomas, which must be immediately removed and the bleeding stopped. In such cases, the mortality rate is very high. The survivors will long-term treatment and rehabilitation.

Forecast

In mild cases of head trauma, the prognosis is usually good. If there is an injury such as a bruise, concussion varying degrees or basal skull fracture, the survival rate is almost 100 percent. As a rule, such patients are completely cured. After therapy, patients may suffer from headaches, migraines, dizziness, and weather dependence. These symptoms may go away over time or accompany the person throughout life.

The situation is worse with severe fractures of the fragmented and depressed type. Also, complex conditions include an open fracture of the base of the skull. Survival rate for such injuries is usually 50 to 50. Some patients do not even survive to operating table. Others die within the first day of surgery. Usually, after this time, the chances of life increase many times over. Such patients can either be completely rehabilitated or remain disabled. It all depends on the severity of the injury. In any case, the rehabilitation process is long and painful.

Rehabilitation

Rehabilitation in mild cases is quick and without consequences. It includes:

• long rest;
• walks in the open air;
• dietary nutrition;
• taking mild sedatives;
• drugs to improve cerebral circulation;
• following the doctor's recommendations.

Often such patients are treated at home. TO minor injuries heads can be classified as:

• bruises;
• concussions;
• closed fracture of the base of the skull.

The lifestyle of such patients, as a rule, is the key to successful treatment.
For severe skull fractures, rehabilitation is long and painful. Most dangerous forms such states:

• open fracture skull base;
• depressed;
• fragmentation

The lifestyle of such patients changes greatly. Not everyone will be able to return to normal behavior. Such patients spend a long time in the hospital. Then transferred to home treatment. Often, patients with this diagnosis are recommended to visit a sanatorium. Rehabilitation can take years.

Fracture of the base of the skull in children

What should you consider if your child is diagnosed with a basal skull fracture? Consequences. The baby’s lifestyle can change significantly, so parents try to ask the doctor in as much detail as possible about the severity of such damage. Head injuries in children occur frequently, despite general opinion that a child’s skull is stronger than an adult’s. Doctors unanimously say that this is not so. Children themselves are very active and inattentive. Sometimes it’s hard to foresee trouble in time. Linear fracture, fragmentation, depressed, fracture of the base of the skull - in children, such injuries account for 70 percent of all head injuries. Symptoms, diagnosis and treatment are no different from adult injuries. In such cases, special children's medications may be recommended to improve cerebral circulation.

What to do before the doctors arrive?

For any traumatic brain injury, contact medical institution Necessarily. If the victim is conscious, he is placed on his back until the ambulance arrives. You can apply cold to the damaged area. IN difficult situations when the patient does not respond to external stimuli, it must be carefully laid on its side and supported with soft improvised objects. It is also necessary to support the head with something soft, such as clothing or pillows, so that the victim does not choke on his own vomit. Plus, this will prevent your tongue from sticking. You need to call an ambulance as soon as possible, saying that the person is in in serious condition. It is not recommended to do anything else until the doctors arrive. It is strictly forbidden to feel the victim’s head yourself.

A calvarial fracture is a very severe one, which is characterized by damage bone structure cranium. In this case, such fractures can be located in the back of the head, temples, ethmoid and wedge-shaped parts of the head.

Consequences of injury

Fractures of the calvarium cause rupture of the hard part meninges. During this process, a hole is formed through which cerebrospinal fluid (CSF) leaks out. Such a hole may be located in the middle ear, mouth, sinuses, or in the eye socket. In addition, in addition to fluid leakage, the patient may develop pneumocephalus or various microbial infections may occur that damage brain tissue.

Signs and symptoms of a skull fracture:

• hemorrhage under the conjunctiva and periorbital tissue;
• nosebleeds;
• formation of subcutaneous emphysema;
• damage to the optic nerve.

All skull fractures are classified as open injuries heads. If the patient has a copious flow of blood and brain fluid, then this already indicates an open craniocerebral injury of a penetrating nature. In addition, this head injury can be located on the anterior, middle and posterior cranial fossa.

Most often, damage occurs to the cranial fossa located in the middle. Such cases account for 50-70% of the total number of basal skull fractures. In this case, the type of bone fracture can be longitudinal, oblique or transverse. If the patient is diagnosed with trauma temporal bone, then in this case there may be a separation of its top and rupture eardrum. This will lead to a sharp deterioration in hearing and the appearance of bruises in the mastoid area.

Fracture of the temporal bones occurs when strong impact along the back of the head and is characterized by damage facial nerve. Moreover, the work is disrupted vestibular apparatus and there is a loss of taste.

When the cranial fossa located in front is injured, nasal liquorrhea and severe nose bleed. In addition, the patient has a symptom of “glasses” (the appearance of bruises in the eyes). Such bruises occur 30-40 hours after injury.

Periodically, damage to the anterior fossa leads to the formation of emphysema. The reasons for its occurrence are the entry of air from the nose into the lobes frontal bone and into lattice partitions. When the occipital part is damaged, the caudal group is damaged nerve endings, which impedes the performance of the entire body.

First aid

If a person receives such an injury, first aid should be provided immediately. If the victim is conscious and can move independently, he should be placed on a stretcher, which should not have a pillow under his head and back. Open wound it is necessary to treat with antiseptics and apply a loose bandage.

Then, when the victim is unconscious, he should be placed on his side. In this case, the injured part of the head should be on top, and a cushion of folded clothing should be placed under the back. This will prevent the person from rolling backwards. IN mandatory the head should be turned to the side, this will help the patient not to choke on his own vomit. Tight clothing must be loosened, and existing prosthetic teeth, eyes and glasses are removed.

If there is a failure respiratory process, then it's done artificial respiration. It is best to do it through a special mask. Then an injection is given with a drug that stimulates the heart, but you should avoid taking painkillers, as this can disrupt the respiratory process.

If possible, glucose solution or Lasix should be administered intravenously. If the patient experiences agitation of motor activity, then Suprastin or Cordiamin is injected intramuscularly.

In the event that the ambulance's arrival is delayed, an ice pack must be applied to the patient's head. This will help remove painful spasms and stop the bleeding. If he has hard breath, then you can take diphenhydramine and bandage the wound.

Consequences of injury

The consequences of a fracture of the base of the skull vary, and their severity will depend on the nature of the injury. Moreover, this may be influenced various pathologies resulting from traumatic infection of soft brain tissue. When diagnosing a fracture without bone displacement, which does not cause purulent formations, there is a very high probability favorable outcome affairs.

If complications develop infectious nature(meningitis, encephalitis, etc.), then, most likely, the person will develop encephalopathy and uncontrolled jumps in the future blood pressure. This can happen especially often in children (babies or infants), since their body has not developed a strong immune system. When such a diagnosis is made, affected people may experience epileptic seizures, accompanied by severe headaches.

Open craniocerebral injuries are always accompanied by heavy bleeding.

If a person is not provided with timely medical assistance, he may die. Stopping the bleeding is especially important in the first hours after a skull fracture, as this can cause the patient to go into a coma. In such situations, it is rarely possible to save a person's life.

A favorable outcome and minimal health loss after receiving a skull fracture completely depend on the degree of its severity and the quality of the treatment provided. Therefore, in order to reduce the likelihood of side ailments, you should seek help from qualified professionals.

The treatment process and its varieties

Treatment of a fracture can be done by different methods. Among them there are conservative method And surgical intervention. Besides, great attention should be given further preventive measures. During treatment, the patient should be examined by a neurologist, ophthalmologist and otolaryngologist.

A conservative technique is used to treat mild forms of damage to the skull and middle ear, especially when the likelihood of bleeding is low. During such treatment, the patient should only remain in bed, and his head should lie on a hill. This position reduces the risk of spinal cord fluid leaking.

In addition, he should have periodic lumbar puncture. In this case, 30-40 ml of cerebrospinal fluid, subarachnoid insufflation and a small amount of oxygen should be infused. The frequency of this procedure is 1 time every 2 days. Diuretics are prescribed. Diakarb helps especially well, since it contains substances that reduce the production of brain fluid.

It is very important to prevent the formation of ulcers, which can cause serious complications. To do this, clean the ear canals and oral cavity. In addition, antibacterial drugs are prescribed.

If ulcers develop, then the use of antibacterial drugs is combined with endolumbar administration of antibiotics. Among such antibiotics, Levomycytin and Polymyxin can be noted. Kanamycin or Monomycin.

Surgical intervention is prescribed when there is a comminuted or depressed fracture of the anterior parts of the skull, basal vault or temporal parts. It is especially important to perform the operation when compression of the brain occurs due to pneumocephalus.

The operation is performed when it is not possible to remove purulent formations with medications and physiotherapy. After opening the skull, the neurosurgeon must carefully scrape out all formations that cause suppuration.

Also, surgical intervention is prescribed in case of relapses of the disease (bleeding, etc.) that occur after the procedure. conservative treatment. Similar treatment will help reduce intracranial pressure and normalize brain function.

Serious injuries can pose a threat to human life and health. But, unfortunately, no one is safe from them. To one of the most dangerous injuries include skull fractures. They can occur when falling from a height, especially on the head, during a direct impact or during a serious accident, etc. Such conditions require especially close attention, as they can become complicated and lead to the most various disorders health. And them timely diagnosis And adequate therapy often avoid such problems. Let's talk about what a fracture of the bones of the vault and base of the skull is, discuss the signs of such conditions and their possible consequences.

All fractures of the skull bones are divided into fractures of the cranial vault and the base of the skull.
When the vault of the skull is fractured, the integrity of the braincase is disrupted, and when the base of the skull is fractured, the bones that enter the base are damaged. brain section skull (temporal, sphenoid, occipital or ethmoid).

Signs of calvarial fractures

When the bones of the cranial vault are fractured, the victim may experience local manifestations of the injury, for example, a hematoma on the scalp, a wound, or depressions that are visible to the naked eye or noticeable upon palpation.

General symptoms This condition is determined by the degree of brain damage. They can be represented by disturbances of consciousness, ranging from short-term loss of consciousness and up to deep coma.

The patient may be affected cranial nerves, develop respiratory disorders and paralysis.

To determine the complexity of the injury, doctors try to assess the condition of the victim. He may be fully conscious, but have absolutely no memory of how the injury was received or what events preceded it. Experts classify this condition as retrograde amnesia. Sometimes the patient develops stupor or coma. It is worth noting that the degree of impairment of consciousness is directly related to the severity of the skull injury. With a fracture of this kind, the victim experiences bradycardia.

Quite often, fractures of the bones of the cranial vault occur in people who are in a state of alcohol intoxication. For staging accurate diagnosis Often you have to wait until they sober up and only then undergo an examination by a neurosurgeon or neurologist.

Quite often, fractures of the cranial vault lead to the formation intracranial hematomas. Such conditions often develop subacutely. The patient first loses consciousness, then comes to his senses and a period begins imaginary well-being, after which the victim again falls into an unconscious state.

Fracture of the bones of the base of the skull - signs of the condition

The manifestations of such injuries largely depend on the location of the injury. So most often doctors encounter fractures of the middle cranial fossa. They make themselves felt by bleeding from the ear, as well as discharge cerebrospinal fluid through the ear due to perforation of the eardrum. The victim's hearing decreases, bruising occurs in the area of ​​the temporal muscle, as well as the mastoid process.

With a transverse fracture, hearing is completely lost and is also impaired. vestibular function and the ability to sense taste with the front part of the tongue disappears due to injury to the tympanic chord.

When a fracture of the anterior cranial fossa occurs, the patient leaks blood and cerebrospinal fluid through the nose. In addition, severe bruising occurs in the area of ​​the lower and upper eyelids, which is classified by experts as a symptom of “glasses”.

If a fracture of the posterior cranial fossa occurs, the patient will experience unilateral or bilateral bruises behind the ears. Simultaneous damage to the abducens, auditory and facial nerves also occurs. In addition, rupture of the caudal nerves may occur and bulbar symptoms: paralysis or paresis of the muscles of the palate, tongue, and larynx. Possible disruption of vital functions important organs.

Fracture of the bones of the vault, fracture of the bones of the base of the skull - consequences

The consequences of skull fractures depend on their severity, individual characteristics patient, correctness and timeliness of first aid.

So, if there is a fracture of the cranial vault without displacement of the bone, the prognosis is favorable.

The development of infectious complications is fraught with the occurrence of encephalopathy and uncontrolled surges in blood pressure. Epileptic seizures are also possible. In addition, many patients who have suffered a fracture of the skull bones are faced with a problem that often appears headache, migraine.

Lack of adequate and timely medical care may lead to coma and death.

In some cases, injuries to the base of the skull lead to curvature of the spine ( varying degrees and different localizations).

Brain damage can lead to impairment various functions organism (motor, visual, auditory, olfactory, breathing problems, etc.), may also be impaired mental functions. Sometimes partial or complete paralysis of the body develops.

Folk remedies

Remedies will help to cope with the consequences of skull fractures traditional medicine. So most of the patients who have suffered such an injury are faced with the problem of headaches. To correct them, doctors often advise using medications to plant based.

This is how the evasive peony plant gives a good effect.

Infusion of peony evasive for bath. A handful of crushed petals of this plant Brew a liter of boiling water. Infuse this remedy for fifteen to thirty minutes, then pour it into the prepared bath. Take a bath with peony for fifteen minutes, then go to bed.

For successful recovery after fractures of the skull bones, healers also advise using rose hips. You will need the fruits of this plant, chop them.

Decoction of rose hips. Brew a tablespoon of the resulting raw material with four hundred milliliters of boiling water and cook over low heat for ten minutes. Pour this decoction into a thermos and leave for a day. Take the finished strained medicine one hundred milliliters twice a day. The rosehip drink can be sweetened with honey.

The advisability of using traditional medicine must be discussed with your doctor.

All of the brain injuries described above can either occur without compromising the integrity of the skull bones or be accompanied by their fractures.

A calvarial fracture can be linear or depressed. Linear fractures occur when struck with large area contact (for example, when falling from a height onto a flat surface). If the area of ​​the impact surface is small, then a depressed fracture occurs when the bone fragment is, as it were, immersed in the cranial cavity. In this case, the shape of the fracture, as a rule, corresponds to the shape of the instrument of injury. In children of the first year of life, peculiar fractures of the cranial vault are sometimes observed. Thus, children with sutures that are not completely ossified may have linear fractures due to divergence of the sutures, so-called diastatic fractures. Depressed fractures in infants are also distinctive - these are the so-called “ping-pong ball” fractures, depression of the bone without violating its integrity, due to bending. Such fractures do not require surgical treatment, excluding localizations in which this leads to cosmetic defects.

One of the most known symptoms a fracture of the base of the skull is a paraorbital hematoma (“symptom of glasses”). It must be remembered that this symptom has diagnostic value only if the victim did not have an injury to the periorbital region or bridge of the nose. There is also leakage of ichor or cerebrospinal fluid from the nose and ears. A characteristic feature a fracture of the base of the skull is the so-called “teapot symptom” - when the flow of ichor or colorless transparent liquid from the nose increases when the head is tilted forward, from the ear - when tilted in the appropriate direction. The flow of pure blood indicates an ear or nose injury rather than a skull fracture. In addition, when the base of the skull is fractured, cranial nerves can be damaged. Depending on the location of the fracture, disturbances in the sense of smell, vision, hearing, and facial asymmetry may be observed. Among the complications of a fracture of the base of the skull, complications associated with infection from the nasopharynx, middle ear or paranasal sinuses entering the cranial cavity are very dangerous: brain abscesses (ulcers) and meningitis.

Fractures of the skull bones are usually associated with various injuries brain. There is no direct correlation between the severity of brain damage and the type of fracture. However, as a rule, depressed fractures are accompanied by more severe damage than linear ones; they often cause the development of epi- and subdural hematomas, while with linear fractures, brain damage can be limited to contusion, or even concussion.

We must remember that a blow to the head does not always cause traumatic brain injuries, and traumatic brain injuries are not always the result of a blow to the head. Cases of fracture can be called “classics of the genre” cervical spine spine in careless divers who jumped into the water in an unfamiliar place and hit their heads. On the other hand, a seemingly innocent joke with a chair being pulled out often ends in a concussion or even a brain contusion - when you fall on your tailbone, the blow is transmitted throughout spinal column. Motorists also experience concussions during emergency braking or in a collision due to a sharp displacement of the brain inside the skull due to inertia.

Features of first aid for closed skull trauma.

First aid for head injuries must be provided with particular care: avoid unnecessary movements and pressure, use a sterile bandage and antiseptics so as not to introduce infection into the tissues surrounding the brain. An infection that gets into the wound can penetrate inside the skull and infect the brain and its membranes. As a result, such serious illnesses such as encephalitis or meningitis. First aid procedure for head injury If the victim is unconscious, then it is necessary to check the breathing/pulse and, if absent, do artificial respiration and cardiac massage . If there is breathing/pulse, then it is necessary to lay the person on his side (to avoid blockage of the airways with the tongue and vomit) and call an ambulance. If there is consciousness, then simply place the victim in a semi-lying position so that he does not move until the ambulance arrives. A person with a head injury should not be sat down, much less tried to be lifted to his feet - this can dramatically worsen his condition. If there is no obvious damage to the bones of the skull, cold (moistened cold water cloth or ice in a rag). This will reduce pain and stop tissue swelling, which leads to increased intracranial pressure.

If there is a bleeding wound on the head, it is necessary to lubricate the skin around the wound with iodine or brilliant green (to prevent infection). Then place a gauze pad on the wound and bandage head. But this should be done very carefully, especially if there is a suspicion of a skull fracture. There is no need to give the victim a lot of liquid; if he is thirsty, give him a little sweet drink. If pieces of bone, metal or other foreign bodies, touching or removing them is strictly prohibited. This is fraught with serious consequences, as heavy bleeding and tissue damage may begin. In such cases, a bandage using a roller rolled up like a donut is recommended. To do this, roll the cotton wool into a “sausage”, wrap it with gauze or a bandage and place it around the protruding object. The wound is covered with a sterile napkin (in two or three layers) and bandaged. The victim can also only be transported in a supine position.

Open skull injuries.

Open injuries to the skull and brain can occur from non-gunshot /secondary/ projectiles and from gunshot wounds. With non-gunshot wounds, lacerations and contusions of various sizes and shapes are most often observed with damage only to soft tissue or accompanied by damage to the bone, meninges and brain. Cut, stab and scalp wounds are much less common. Gunshot wounds of the skull and brain can be of a different nature: fragmentation and bullet (ball, arrow-shaped and other wounding projectiles), blind, tangential, through and ricocheting.

Depending on the location, there may be injuries to the vault, base of the skull, they can occur on the right or left, be single, multiple, combined, with damage to other organs and systems, combined, etc.

Skull wounds are divided into:

Soft tissue injuries / without bone damage /,

Non-penetrating injuries of the skull /extradural/, in which there is a bone fracture, but the dura mater remains intact,

And penetrating injuries of the skull and brain /intradural/,. accompanied not only by damage to the bone, but also to the meninges of the brain.

The clinic of penetrating wounds is characterized primarily by the loss of consciousness of the wounded as a result of extreme inhibition of nerve cells. The duration of disturbances of consciousness can vary - from several minutes to several days, and the degree ranges from the phenomena of slight stupor or drowsiness to a state of stupor or coma.

Along with loss of consciousness, the wounded may experience vomiting, psychomotor agitation, and increasing bradycardia.

Providing first aid for injuries to the skull and brain comes down to applying an aseptic dressing to the wound, simple immobilization and rapid evacuation to a medical facility.

The application of an aseptic dressing for open penetrating injuries of the skull with bulging of the brain has some features. The wound is covered with a sterile napkin, and a cotton gauze roll in the shape of a “donut” is placed around it in order to prevent the bandage from compressing the brain substance protruding into the wound. After this, the napkins and the roller are strengthened by applying one of the accepted standard dressings / “cap”, “bridle”/. Immobilization is the simplest / deepening on a stretcher /. Splints are rarely applied. The victim's head is turned to the side.

3. Damage to the spine and spinal cord. First aid for them.

IN general structure of injuries, skull fracture accounts for 20-30%, and among the causes of mortality and disability resulting from trauma - 40-60%, ranking first.

Skull fracture – violation of integrity bone tissue, in this case, a distinction is made between penetrating, with damage to the dura mater, and non-penetrating, without damaging it.

A skull fracture can be open (with damage to the skin and underlying tissues) and closed (without damage to the integrity skin). Skull fractures are divided by location into injuries to the vault and base of the skull.

Skull fracture ranks first among causes of death and disability

Cranial vault fractures

They are divided into linear and depressed. Linear fractures go through the veins of the spongy substance of the skull, the arteries of the meninges, the projection of the passage of the sinuses of the dura mater, and can injure these vessels, which leads to a significant accumulation of blood in the space between the skull and the dura mater. Comminuted and depressed fractures damage dura shell brain and blood vessels.

The consequences of this are the formation of a hematoma located between the hard and arachnoid membranes brain

General state patient is directly related to the size of the fracture, the degree of brain damage, associated complications. The clinic is formed from general cerebral, focal neurological manifestations.

Symptoms may be present in the clinic for a depressed fracture focal lesion, epileptic seizures. Depressed fractures of at least the thickness of the bone are subject to surgical treatment as early as possible, except for indentation in the area frontal sinus.

Fractures of the base of the skull

Based on their location, fractures of the anterior, middle and posterior cranial fossae are distinguished. Trauma to the ethmoid bone is manifested by the leakage of cerebrospinal fluid and blood from the nose. Damage to the integrity of the temporal bone pyramid is characterized by bleeding from the ears and complete break eardrum.

For fractures of the anterior cranial fossa, bruising around the eye sockets, leakage of cerebrospinal fluid and blood from the nose, impaired or complete loss of the sense of smell, and a unilateral decrease in visual acuity are typical.

Bruising under the eyes is typical of a skull fracture

Fractures of the middle cranial fossa often pass through the pyramid of the temporal bone, which is manifested by bleeding and leakage of cerebrospinal fluid from the ear and nasopharynx, decreased hearing, and disruption of the activity of the facial nerve. Fractures of the posterior cranial fossa are the most severe with damage to the brain stem.

Damage to the bone tissue structure passing through the sinuses is dangerous for the development of meningitis.

Diagnostics

Along with clinical picture fracture, assistance in diagnosis is provided by:

• puncture study;
• X-ray examination of the skull;
• magnetic resonance, CT scan;
• echoencephalography.

Features in children

The specificity of the child’s body is less fragility and high elasticity of the skull bones.

Distinctive feature fractures of the skull vault received by a child is their “concavity,” which is explained by the increased elasticity of the bone, allowing it to bend easily without breaking.

In injuries accompanied by a head impact on a hard surface, the sutures become separated and multiple linear fractures of the cranial vault appear - cracks.

A child, less often than an adult, experiences fractures of the base of the skull, extensive hemorrhages between the arachnoid and pia mater, and intracranial blood collections.

Because of age characteristics child, fractures of the skull bones in childhood, especially early childhood, go away more easily. But then they can form dangerous consequences, such as hydrocephalus, epilepsy.

U infant When the bones of the skull are fractured, loss of consciousness most often does not develop. General stupor is replaced by increased physical activity. Oscillations muscle tone, reflexes appear dimly. The pathology of movement is determined by the reduced function of the injured limbs. The child has an older age group The clinic is characterized by unstable cerebral manifestations and autonomic disorders. There is loss of consciousness, nausea, severe vomiting, dizziness, anxiety. These phenomena are quickly replaced by apathy, lethargy, and tearfulness.

In a newborn with bulging of the large fontanel and other symptoms of compression of the brain, its puncture is recommended. In an older child, angiography and therapeutic and diagnostic craniotomy provide assistance in clarifying the diagnosis.

Treatment at different stages

The patient’s recovery directly depends on the correctness and completeness of medical care at all its stages.

Principles of first aid:

1. In case of a skull fracture, first aid should be provided immediately at the scene of the incident.
2. If the victim is unconscious, then when providing assistance there is no need to shake him or lift him, so as not to aggravate the severity of the condition.
3. Immobilization - limit the mobility of the head, create shock absorption to prevent shaking and jolts. The victim’s head is placed on a cotton-gauze circle or an improvised object with the back of the head in the hole to limit the mobility of the head.
4. Using Kramer splints - one of the splints is curved so that it covers the forehead, follows the contours of the head from front to back and the curve of the neck up to thoracic spine; the other bends in the shape of the shoulder girdles and head on top of the first splint. When they are applied, the head is tilted back slightly and secured with bandages.
5. Transport the victim on a stretcher, in a supine position without shaking, with the head fixed.
6. To prevent blood, cerebrospinal fluid, or vomit from entering the Airways tilt your head back and turn it to the side.
7. Simultaneously with the provision of first aid, urgent hospitalization to a specialized neurosurgical department.

Doctor's tactics when open damage skull consists of the primary step-by-step gentle treatment of the skin, bone, meningeal, and medulla layers of wounds according to classical principles, preferably no later than 12 hours after the injury occurred.

When performing surgical treatment of a wound in a child, it is necessary to recreate the integrity of the dura mater using fascia grafting, because achieving sealing of the cranial cavity solely through the skin most often does not prevent the leakage of cerebrospinal fluid.

In some cases, with a skull fracture, it is necessary surgery

In a child, single-fragment, concave fractures of more than 1.5 cm of the bones of the cranial vault are a direct indication for immediate surgical treatment. This becomes especially relevant when signs of focal brain damage appear. Treatment tactics for such consequences are justified by the fact that in an unoperated child under 3 years of age, a bone tissue defect with raised calcified edges often forms at the site of a depressed fracture after 3-12 months. This is explained trophic disorders in the bones of the skull, membranes, and brain, which occurred due to prolonged detachment of the periosteum and accumulation of blood under it.

Most often, after successful completion of the initial surgical treatment wounds, with the removal of bone tissue fragments, craniotomy, resolve the issue of performing primary cranioplasty.

Contraindications for surgery:

• extensive brain defects;
• significant swelling of the brain;
• condition after removal of large hematomas, since an increase in edema is possible;
• presence of signs of wound inflammation.

After completion of surgical treatment in a hospital, outpatient care should be provided by a specialist with continued drug treatment, subsequent dispensary observation from a neurosurgeon.