Traumatic brain injury, fracture of the temporal bone. Temporal bone fractures

The study of large statistical data and our own observations give reason to believe that pronounced lesions of the ear occur more often with fractures of the base of the skull and are a consequence of the involvement of the pyramid of the temporal bone. The fracture line of the pyramid determines which elements of the ear are affected, what the symptoms of the lesion are and its consequences. In this regard, attempts to classify temporal bone fractures according to the direction and location of the cracks are understandable. There are longitudinal, transverse and combined fractures of the pyramid, but these three groups do not fit all the common types of fractures. In this regard, an atypical form has been identified.

Rice. 37. Transverse fracture of the skull and longitudinal fracture of the labyrinth (a); longitudinal fracture of the skull and transverse fracture of the labyrinth (b).

At longitudinal fracture(Fig. 37, a) the crack runs along the roof of the tympanic cavity and the upper wall of the bony auditory canal and divides the pyramid into anterior and posterior parts. The anterior one includes part of the auditory canal and the tympanic cavity, the posterior one includes the entire labyrinth and the facial nerve canal.

At transverse fracture(Fig. 37, b) pyramidal fissure passes through the mass of the inner ear, vestibule, cochlea, semicircular canals, as well as the facial nerve canal.

At combined(Fig. 38) fracture the fracture line runs from the posterior surface of the mastoid process or pyramid to the posterior lacerated foramen. The area of fracture usually includes the posterior wall of the external auditory canal, the roof of the tympanic cavity, the facial nerve canal, and the inner ear. An oblique fracture occurs mainly with a blow to the occipital region.

Rice. 38. Combined fracture of the labyrinth.

It is possible to schematically outline the clinical symptomatology common for each group. A longitudinal fracture is characterized by bleeding from the ear, rupture of the eardrum and slight hearing loss. Occasionally, there are other symptoms - liquorrhea, paresis of the facial nerve, usually transient, and deafness.

Hearing loss is associated with changes in the middle ear and has a sound-conducting nature, but sound perception is often impaired. The cause is labyrinthine compression, which is possible with any type of fracture. In the same way, hemorrhage in the inner ear cannot be ruled out. These points are of great importance in the pathogenesis of damage to the functions of the labyrinth, as evidenced by the convincing data of Ulrich (1926), who found unilateral complete deafness in 17% of patients, and a significant decrease in hearing in 28%.

The most severe damage to the inner ear occurs when transverse fracture pyramids. Typical for this type of injury are unilateral complete deafness, loss of vestibular function and facial paralysis. It should, however, be pointed out that such a lesion occurs with a total fracture of the labyrinth; Often there are only partial fractures, cracks of the bone capsule of the labyrinth, leading to a limited decrease in function - loss or decreased perception of individual tops. With a transverse fracture of the pyramid, the eardrum remains intact; in the middle ear there is only sometimes a slight hemorrhage when the fracture line passes through the inner wall of the middle ear. With a longitudinal fracture, significant changes occur in the tympanic cavity - rupture of the eardrum, tendons, muscles, and fracture of the auditory ossicles. One of the common signs is hematotympanum - an accumulation of blood flowing from vessels damaged by a fracture of the roof and the inner wall of the tympanic cavity. The membrane is intact and takes on a dark blue or pink color and appears somewhat bulging.

According to the observations of B. S. Preobrazhensky, in one patient, 2 weeks after a longitudinal fracture of the pyramid, the eardrum became almost black. The literature describes liquor tympanum - an accumulation of cerebrospinal fluid in the tympanic cavity, which penetrates through a crack in the meninges and in the roof of the cavity (Voss).

With an oblique fracture of the pyramid, the cracks can pass in such a way that they involve different parts of the ear and therefore it is difficult to identify characteristic symptoms. This applies even more to atypical fractures.

In the diagnosis of pyramidal fractures, radiography is of great importance; with its help, fracture lines can be recognized in detail. However, there is a peculiar fracture of the pyramid, microscopic, which is rarely visible on an x-ray. Such fractures were found during histological examination of the temporal bone. They pass either through the entire pyramid or only through the bone capsule of the labyrinth. In the latter case, due to the peculiarities of the anatomical structure of the capsule, regeneration does not occur and the fracture does not heal. The presence of communication between the tympanic cavity and the inner ear is particularly dangerous in case of inflammatory disease of the middle ear.

Assessing the role of head trauma in the etiology of deafness and hearing loss, we can assume that the greatest threat to ear function is posed by transverse fractures of the pyramid of the temporal bone, and then oblique ones. Longitudinal fractures are important mainly due to the possibility of developing purulent inflammation in the middle ear.

Purulent diseases of the middle ear that develop in connection with a fracture of the base of the skull have their own characteristics that affect the symptomatology and clinical course. The most important of them is the presence of cracks in the internal bone plate and the associated risk of infection spreading into the skull. Otitis media has a severe course with deep damage to the mucous membrane and the presence of bone sequesters.

Temporal bone- this is one of the bones that makes up the base of the skull, covers the temporal(lateral) brain area. It is a steam room: there are left and right parts. Fractures of the bones of the base of the skull occur in 4% of all cases, of which 75% are fractures of the temporal bone specifically.

Photo 1. Head injuries are among the most dangerous due to the possibility of brain damage. Source: Flickr (Dion Hinchcliffe)

Structure of the temporal bone

The temporal bone is formed as a result of the fusion of 3 bones: the squamosal, the tympanic and the pyramidal (petrous), the fusion sites are marked by grooves. Complete fusion of the bones occurs by the end of the first year of life and closes the external auditory canal.

The temporal bone has several processes that are involved in the formation of the auditory canal, jaw joint, and muscle-ligamentous apparatus. The bone is also penetrated by 9 channels through which nerves (facial, vagus, trigeminal) and blood vessels (tympanic vessel, aqueductal vein, internal carotid artery) pass.

Pay attention! Injuries to the temporal bone are very dangerous for human health and life, as they can lead to neurological disorders of varying severity, complications such as meningitis, hearing loss, and severe hemorrhage when the carotid artery ruptures.

Causes of fractures

A temporal bone fracture occurs due to a blow from a hard object to the temporal region of the skull(a strong blow to the temple in a fight, hitting the corner of furniture when falling, etc.). This bone is quite thin, so local pressure on it very often results in a fracture.

Temporal bone fractures in children

In children under one year of age, the fusion of the components of the temporal bone is not yet complete; in the preschool years articulations still pretty weak. For this reason, and also due to increased physical activity in children, temple fractures are quite common.

This is important! It is worth considering that a child’s bone density is quite low, and the nervous system is still imperfect, so head injuries can have the most severe consequences.

Types of temporal bone fractures

Depending on the location of the blow, the fracture can occur in any part of the temporal bone: tympanic, squamosal, pyramidal, various processes, and sutures may split.

Fractures of the tympanic labyrinth

With such fractures there is opening of the tympanic cavity, which is accompanied by bleeding from the ear (sometimes it is not blood that is released, but cerebrospinal fluid). In some situations, blood cannot leave the ear and a bruise forms behind the auricle (Battle's sign).

Temporal bone squamous fracture

This type of fracture is one of the most common injuries although in this case displacement of fragments is often observed. Usually the injury is accompanied by hearing impairment. Externally, it may manifest as bleeding from the ear or nose; periorbital ecchymosis is rarely seen.

Fractures of the pyramidal bone

The most difficult from the point of view of treatment and prognosis are fractures of the pyramidal bone. With such injuries, patients often lose consciousness (for up to several days) and may even fall into a coma.

Fractures of the pyramidal portion of the temporal bone are one of the most common causes of mortality in traumatic brain injuries. There are 3 types of fractures:

Transverse. With such an injury, the patient loses consciousness (the duration of unconsciousness depends on the severity of the injury), possible hemorrhage from the nose and ears, Battle's symptom, periocular ecchymosis, horizontal nystagmus, effusion of cerebrospinal fluid. Complications include hearing impairment (rarely vision), paralysis of the facial nerves, loss of vestibular function, neurological autonomic disorders and other symptoms of TBI. Depending on the severity of the injury, the consequences can be either reversible or irreversible. In especially severe cases, a vegetative state and even death may develop.
Longitudinal. Such a fracture can develop due to a blow to the parieto-occipital region. This injury usually does not affect the labyrinths of the capsule, but can seriously damage the facial nerves and blood vessels. For this reason, the symptoms of a longitudinal fracture of the temporal bone are very pronounced: rupture of the eardrum or hemorrhage into it, leakage of blood or cerebrospinal fluid from the ear, loss of consciousness, nausea and vomiting, paresis of the facial nerves, and so on.
Atypical. This injury involves the smallest and thinnest areas of the temporal bone, including the capsules of the labyrinth. The patient exhibits hearing loss, however, maintains a sense of balance. Dizziness is also observed with sudden movements of the head. Bleeding from the ears is extremely rare.

Signs of a temporal bone fracture

Depending on the location of the injury and its severity, the symptoms will differ slightly. However, there are a number of indicative symptoms that may indicate a temporal bone fracture:

gaping wound at the site of injury (),
damage to the soft tissues of the temporal region of the skull without compromising the integrity of the bone,
dizziness and nausea of the victim,
loss of consciousness, coma,
paresis and paralysis of the facial nerves,
hearing impairment or loss,
bleeding from the ear,
Battle's sign,
leakage of brain fluid from the ears or nose,
nosebleed,
horizontal nystagmus,
visual impairment,
periocular ecchymosis (bruising around the eyes),
might happen seizure.

If the above symptoms appear, the victim must be transported to the emergency room or neurological department. If a person is unconscious, you must call an ambulance.

First aid for a temporal bone fracture

For a closed temporal lobe fracture, it is necessary provide the victim with maximum peace and, if possible, deliver his to a medical institution. You can apply a cool, damp towel to your head.

This is important! Under no circumstances should you heat your ear or put anything in it if you have a temporal bone injury!

In the case of an open fracture, you should not wash the wound, as this action can contribute to infection and subsequent complications. If possible, you can impose on the wound and take the victim to the hospital. If the patient is unconscious, you need to call an ambulance to transport him.

Diagnosis of a fracture

In terms of external symptoms, a fracture of the temporal bone is similar to a concussion. A distinctive feature is bleeding from the ear. However, injuries to other bones that make up the base of the skull have similar symptoms. To do this, it is necessary to carry out differential diagnosis.

The most informative method for diagnosing bone fractures is radiography. Due to the structural features of the temporal bone, for an accurate diagnosis it is necessary to perform fluoroscopy in 3-4 projections. It is also possible to conduct an MRI, and laboratory tests of blood and leaking cerebrospinal fluid are prescribed.

Treatment of a temporal bone fracture

In most cases, with this injury, it is indicated conservative treatment. Surgery is performed only in cases of open or displaced fractures. You may also need mastoidotomy(dissection of the mastoid process) and eardrum drainage.

Conservative treatment mainly consists of anti-infective therapy, since in other cases (for example, bone fusion) recovery occurs spontaneously.

This is important! A fracture of the temporal bone extremely rarely consists of a fracture itself. In many cases, there is a concussion or contusion of the brain, and sometimes damage to the brain matter. Therefore, this injury often requires treatment from a neurological point of view.

Without proper neurological care, the patient is at risk of numerous complications that can significantly reduce his quality of life.

Complications of temporal bone injury

The consequences of a fracture for a person depend on several factors: the location of the injury, the degree of its severity, the general health of the person and his medical history, the timeliness of first aid, the correct choice and responsible treatment. The most common consequences, which can be either reversible or irreversible:

spontaneous recovery with minimal residual effects (occasional headaches, slight hearing loss);
decreased or loss of hearing;
chronic otitis;
facial nerve damage: disturbance of innervation of facial muscles, paresis and paralysis, pain syndrome;
visual impairment;
purulent meningitis (the danger of its development persists throughout life);
neurological disorders, characteristic of TBI: ataxia and impaired coordination of movements, headaches, speech apraxia, memory loss and other mental disorders.

Rehabilitation after a temporal bone fracture

Typically, for bone fractures, procedures during the rehabilitation period are aimed at restoring the motor function of the injured limb, but the consequences of a temporal bone injury are more similar to a TBI and are more neurological in nature. Rehabilitation of a temporal bone fracture consists of:

(drugs that improve oxygen supply to tissues, vitamins, neuroprotectors, diuretics, sedatives, antibiotics in case of infection);
massage of the head and collar area;
Exercise therapy for disorders of the body’s motor functions;
working with a speech therapist for hearing and speech disorders.

The rehabilitation period takes from 4 weeks to 6 months from the moment of injury. Over the next 1.5-2 years There is still an opportunity to correct some residual effects. After this period, we can talk about established changes.

Prevention of fractures

Photo 2. Simple precautions will help avoid serious consequences.

A fracture of the temporal bone in a child or adult can have serious consequences, since important blood vessels and nerves pass through it. Injuries can lead to loss of balance, hearing, and facial paralysis. Bleeding and pain, and sometimes leakage of brain fluid, accompany injuries.

Structure and functions of the temporal bone

The temporal bone anatomically consists of three parts: squamous, petrous, tympanic, which are separated from each other by slits. The scales have two surfaces: the medulla and the outer. The meningeal nerves pass through it. The tympanum contains the external auditory canal. In the rocky part, the densest part, which forms the base of the skull, is the vestibulocochlear nerve, the organ of hearing and balance.

Learn about the different degrees of severity.

The fracture is accompanied by an increase or decrease in intracranial pressure. When the patient feels nauseated, vomiting occurs. In this case, vomiting does not bring relief, since it is of central origin and occurs due to irritation of sensitive receptors in the hypothalamus. This can also occur with damage to the vagus nerve.

If the patient is unconscious, then vomit can enter the respiratory tract and further cause inflammation in the trachea, bronchi, and lungs.

Damage to brain tissue by bone fragments from a strong blow causes a change in the reaction of one of the pupils to light, which becomes asymmetrical. Damage to the vagus nerve causes disruption of the heart. This nerve inhibits myocardial contraction, and if damaged, tachycardia may occur.

Read about: symptoms, diagnosis and first aid.

What symptoms occur with: clinical manifestations, treatment.

Find out how it turns out and what not to do with a TBI.

The trigeminal nerve, the trunk of which runs in the pyramid of the temporal bone, provides sensitive innervation to the face. If damaged, his face may go numb. With a strong blow, the facial nerve, which is responsible for the motor innervation of the face, can rupture. The consequence of this is facial paralysis and asymmetry.

The main formations are the vestibular-cochlear nerve, which transmits signals from the vestibular apparatus, as well as the organ of hearing. When the temporal bone is fractured, the eardrum often ruptures, the consequences of which are serious, as the patient develops lifelong deafness.

Damage to the nerve plexuses of the hearing organ leads to sensorineural hearing loss. Violation of the integrity of the vestibular apparatus leads to loss of balance both at rest and in motion. The patient feels severe dizziness. Microcracks and microfractures of the bony labyrinth of the temporal bone are dangerous.

Diagnosis of a temporal bone fracture

The first examination that needs to be done if a temporal bone fracture is suspected is a computed tomography scan of the brain. X-rays are performed later. An examination by a neurologist is required to possibly detect paresis of the facial muscles.

Performed on patients:

audiometry;

checking the functions of the vestibular apparatus;

tuning fork tests by Rinne and Weber to determine the nature of hearing loss: conductive or sensorineural.

Treatment

First aid is to apply an immobilizing sterile bandage to the head to ensure immobility of bone fragments. To prevent aspiration of vomit into the respiratory tract, it is necessary to place the head on the uninjured side so that the contents of the stomach do not enter the larynx, but are poured out.

It is necessary to urgently transport the victim to a medical center for a full examination and treatment. If clear fluid leaks from the ear and nose, infection from the external environment should be avoided.

Important! When providing first aid, rinsing and instillation into the ear should not be done to avoid infection of the central nervous system.

In case of facial paralysis on the side of the fracture, the function of the facial nerve is restored. If it is torn, it is stitched end to end. To reduce the intensity of inflammation of the facial nerve, ear suppositories with hormonal agents are used.

Damage to the eardrum requires surgery to repair. Fracture of the ossicles of the hearing aid (hammer, stapes and incus) also requires surgical intervention.

To prevent infectious complications during liquorrhea, antibacterial drugs are used. In case of suppuration, an audit is performed. In case of cerebral edema, dehydration therapy is performed - the administration of diuretics (Furosemide).

Conclusion

The consequence of a fracture of the temporal bone can be sensorineural and conductive hearing loss, dysfunction of the vestibular apparatus, and impaired facial sensitivity. Some injuries can be treated surgically or go away on their own.

Pyramidal temporal bone fractures are often observed in TBI. The cracks of the pyramid are divided into longitudinal and transverse.

Longitudinal cracks account for 3/4 of all such fractures. They occur due to injury to the lateral parts of the skull (parietotemporal). A crack from the calvarium descends to the base, passes through the upper or posterosuperior parts of the external auditory canal, the middle ear and the muscular-tubal canal. The damage is mainly to the middle ear, and to a lesser extent to the inner ear and the facial nerve canal. Clinical longitudinal fractures of the temporal bone pyramid are manifested by bleeding from the external auditory canal due to rupture of the eardrum. Hearing in this ear is reduced, mainly of the sound-conducting type due to injury to the eardrum, bleeding in the middle ear, and dislocation of the auditory ossicles. Taste on the anterior 2/3 of the tongue decreases in the acute period. Prognostically, longitudinal fractures of the pyramid are more favorable than transverse ones, since hearing and taste are restored in most patients, peripheral palsies of the VII nerve are rare, and there is less possibility of infection of the cranial cavity.

Transverse fractures account for 1/4 and run perpendicular to the axis of the pyramid. They occur when there is a blow to the occipital region. Transverse fractures pass through the internal auditory canal, the inner ear (cochlea, semicircular canals), and the facial nerve canal. Transverse fractures of the pyramid lead to damage to the labyrinth with irreversible deafness and loss of vestibular function and taste in the anterior 2/3 of the tongue; there is often insufficiency of the VII nerve on the affected side. Bleeding from the ear does not occur if the eardrum is preserved, but often it is reddish-bluish, and later dark gray in color, because the blood that has poured into the middle ear can be seen through it. Initially, after injury, spontaneous nystagmus of destruction appears, directed towards the healthy side, and later multiple spontaneous brainstem nystagmus usually occurs as a result of edema and dysgemic disorders in the brainstem. Despite the acute shutdown of the labyrinth function, dizziness is often not observed in the acute stage of the disease, since the patients are unconscious, and when consciousness returns to them, the vestibular attack has already passed. Transverse fractures are more dangerous, with a higher incidence of intracranial complications, irreversible loss of hearing, vestibular function, facial nerve and taste in the anterior 2/3 of the tongue.

Since with pyramidal cracks the cranial cavity communicates with the cavities of the middle ear, and through the auditory tube with the nasopharynx, these injuries should be considered open.

If a pyramidal fracture is suspected, the auricle should be treated with alcohol, an aseptic bandage should be applied to the ear, and massive doses of antibiotics and sulfonamides should immediately be given, since the risk of infection of the cranial cavity is very high. Typically, fissures of the temporal bone pyramid are successfully treated conservatively. Gunshot injuries to the temporal bone require surgery.

Traumatic brain injury (TBI) is mechanical damage to the skull and intracranial structures (brain, blood vessels, nerves, meninges).

Manifestations of traumatic brain injury in children differ significantly from symptoms characteristic of adults, and they are due to the characteristics of the child’s body, namely:

the process of ossification of the baby’s skull is not yet complete, the bones of the skull are plastic, flexible, their connection with each other is loose;
the brain tissue is immature, saturated with water, differentiation of the structures of the nerve centers and the cerebral circulatory system is not complete. Thus, on the one hand, brain tissue has greater compensatory capabilities and a so-called safety margin (soft bones of the skull and a larger amount of fluid and brain than in adults can absorb shock). On the other hand, since it is the immature brain tissue that is exposed to trauma, which can lead to disruption of the development of its structures and provoke further limitation of mental development, emotional disturbances, etc.

According to one classification, traumatic brain injuries are divided into:

The baby lies on the changing table or on the sofa, the mother turns away for a few moments, and the baby falls on his butt.
The baby is left unattended in a high chair. He pushes off the table with his feet and falls on his back along with the chair.
The baby is trying to get up in the crib. Something on the floor interested him, and he hangs over the side and falls.
The baby was left sitting in the stroller, not expecting that he would try to stand up in it and, not finding support, would fall down.

Since the relative weight of the baby's head is much greater than the weight of the body, when he falls, he first of all hits his head and most often the parietal region. Very rarely the frontal and occipital areas of the head are injured.

After a child falls, redness appears in the impact area, and the baby feels pain. If, within a few minutes, no pronounced rapidly growing swelling appears in this place, but only slight swelling is noted, then, as a rule, this indicates a bruise of the soft tissues of the head (which does not apply to TBI).

You need to apply something cold to the sore spot (an ice pack, a towel moistened with cold water - do not forget to re-wet it periodically, etc.). A cold compress is applied for at least 5-15 minutes (or at least for as long as the baby allows - often this procedure causes active protest).

A cold compress will reduce tissue swelling, which interferes with the normal functioning of the organ, will narrow the blood vessels, which prevents bleeding and will become an important factor in the favorable outcome of the injury in the future.

The advantages of this procedure are more significant than the mythical possibility of a child becoming hypothermic within such a short period of time. And most importantly, remain calm and try to calm the child.

Fractures of the temporal and parietal zone are often diagnosed in children. The causes of such an injury can be different: from birth trauma to being hit by a heavy object.

As a result of damage to the parietal region, the child's bone is pressed inward. Since newborn babies lack bone in the parietal area, such an injury can occur very easily.

The consequences for the child are very serious.

As a result of trauma in the parietal area in children, hematoma, swelling and abrasions form. Tissue rupture and heavy blood loss may also occur. With more serious traumatic brain injuries, children may experience bleeding from the ears, throat, and nose. Even if a child hits his head slightly on something, it is recommended to consult a specialist.

The first step is to bring the victim into a stationary position by placing a soft object (a piece of fabric, a pillow, a folded blanket) under the head.

IMPORTANT: it is necessary to lay it on the opposite side to the injury site.

The next action, in addition to urgently calling an ambulance, is to monitor all life-support functions - heart rate, breathing.

In cases where, due to a complex injury, cerebral fluid leaks out, signs of an open fracture of the skull bones are observed, it is necessary to apply a sterile bandage. This should be done especially carefully, without making any effort, without squeezing the victim’s head.

If the victim is conscious, he should be calmed down and not allowed to move. There may also be attacks of vomiting and convulsions - you should remember this and be prepared for this.

During the rehabilitation process, a detailed examination is carried out, involving many specialists. The patient's condition is being monitored.

A special diet, medications and procedures are prescribed. One of the folk remedies for restoring bones is eating eggshells. As you know, it contains a lot of calcium, which is involved in the formation of bone tissue. However, a balanced course of vitamin preparations eliminates the use of shells in the diet.

Rehabilitation does not guarantee complete restoration of a person’s health. And the person himself is also able to have a positive effect on his treatment if he gives up bad habits and follows all the recommendations of the attending physician.

A temporal bone fracture is distinguished by the nature and area of damage. There are four main types: linear, open (closed), comminuted or depressed.

A linear fracture is dangerous because the injury leads to damage to the blood vessels of the brain, resulting in the formation of a hematoma inside the brain. The linear type of skull injury is often diagnosed when a child’s head is injured.

Comminuted and depressed skull fractures damage the hard shell of the skull, resulting in the formation of a hematoma in the brain area.

A depressed fracture can result in crushing of the brain. Victims with this type of injury rarely survive. Even if life is preserved, brain activity is severely impaired. The person remains disabled.

Dislocations

The temporal part of the skull is associated with the jaw structure. Subluxation and dislocation of the temporomandibular joint quite often result from trauma to the temporal lobe.

In some cases, subluxation occurs with a strong blow to the parietal area. The pressure exerted on the parietal area affects the jaw structure, which leads to its subluxation (dislocation).

Traumatic brain injury, which is characterized as subluxation of the temporomandibular joint, is diagnosed more often in adults than in children. Subluxation is not always amenable to complete restoration, since complete deviation of the jaw head from the socket is very rarely possible to reinsert into its original place.

After a skull injury, a person may lose memory - completely or partially. A facial surgeon treats skull fractures. First, an x-ray is taken to identify bone abnormalities.

Head injuries can range from fractures to severe bruises, causing concussions and hematomas. This is no less dangerous to health than breaking bones.

The main thing you need to know is that a head injury is associated with the brain, so there can be any disorders associated with impaired brain function - in addition to memory loss, paralysis of the limbs, disruption of the organ of hearing, speech, and also the psyche can occur.

spontaneous recovery with minimal residual effects (occasional headaches, slight hearing loss);
decreased or loss of hearing;
chronic otitis;
damage to the facial nerves: impaired innervation of the facial muscles, paresis and paralysis, pain;
visual impairment;
purulent meningitis (the danger of its development persists throughout life);
neurological disorders characteristic of TBI: ataxia and impaired coordination of movements, headaches, speech apraxia, memory loss and other mental disorders.

Comprehensive rehabilitation of patients with post-traumatic sensorineural hearing loss, subjective ear noise, hyperacusis and vestibular disorders is based on a combination of methods of pharmacotherapy, physiotherapy, psychotherapy, reflexology, intravascular detoxification therapy.

Classification

Fractures vary:

According to the damaged bones of the same name;

Along the cranial fossae of the inner surface of the skull: anterior, middle and posterior;

In relation to the external environment;

By the presence or absence of bone displacement.

The occipital and sphenoid bones are part of the brain section of the skull. The temporal bones form the cranial vault and house the hearing organs: the pyramid of the temporal bone contains the tympanic cavity and the inner ear.

The anterior fossa is formed by the frontal bone, the plate of the ethmoid bone, and is separated from the middle fossa by the edges of the sphenoid bone. The middle fossa is formed by the sphenoid and temporal bones.

The posterior fossa is formed by the occipital bone, the posterior part of the sphenoid bone.

According to the clinical classification, the following types of temporal bone fractures may occur:

fracture of the temporal bone;
fracture of the pyramid of the temporal bone;
linear fracture of bone tissue;
longitudinal fracture;
depressed fracture.

Trauma code according to ICD 10

According to the medical classification of diseases, ICD 10 code: S02 Fracture of the skull and facial bones. This violation of the integrity of bone tissue is not usually classified as open or closed, since it is closed in all clinical situations.

In order to subdivide fractures of the facial bones according to anatomical features and the degree of displacement of their parts, it is necessary to know the structure of the cranium.

Head injuries can range from fractures to severe bruises, causing concussions and hematomas. This is no less dangerous to health than breaking bones.

Due to the structural features of bone tissue, the skull is able to have a certain degree of strength and withstand significant loads without damaging the bones. However, in this case, brain damage often occurs.

The localization, direction and severity of the injury are determined precisely by the unequal elasticity, the presence of nerve, venous and air openings and, associated with this, the thickness of the bone in different sections.

Like other bone injuries, skull fractures can be open or closed.

A vault fracture is a violation of the integrity of the brain. It can be direct when the localization of the injury is limited to the place where the force is applied. In this case, the bones bend inward at the fracture site. With an indirect fracture, when the cracks spread to the entire skull and the bone bends outward.
When the base is fractured, the membranes of the brain and spinal cord are often damaged, and the nerves responsible for vision, hearing and facial expressions are pinched. The fracture can be either independent or accompany a fracture of the arch. The cracks extend to the bones of the nose and eye socket, as well as the area of the ear canal. Depending on the location of the lesion, the anterior, middle or posterior cranial fossa may be affected.

1. Comminuted - are the most common type of fracture and its treatment is often complicated by the location of the injury, the shape and number of bone fragments. Such injuries can lead to bruises, the formation of intracerebral hematomas, and brain crushing.

2. Linear fractures can be local and distant.

In the first case, a linear fracture is a crack that begins at the point of impact and spreads to the sides. Distant linear fractures differ from local ones in that the crack begins at some distance from the point of impact and spreads to this place and in the opposite direction from it.

3. Depressed fractures can be impression (when bone fragments are not separated from entire sections) and depression (bones are separated from the skull).

The type of depressed fracture is determined by the following factors: the area and shape of the damaging object and its relationship with the area of the skull, the force and intensity of the impact, the degree of elasticity of the skull bones and skin.

4. Perforated fractures usually result from gunshot wounds and are often fatal.

With this type of injury, the fracture line runs along the thinnest parts of the bones of the base of the skull; microfractures and very small cracks in the bone capsule of the labyrinth can also be observed.

Reasons

The most common cause of damage to the temporal bone is direct mechanical force (for example, a strong blow with a blunt object or a fall).

Such a fracture usually occurs as a result of a blow from an object with a large area. Usually there are traces of mechanical impact (abrasion, swelling) above the fracture site.

Skull fractures can be: direct, indirect. With direct impact, the bone is deformed directly at the site of impact; with indirect impact, the impact is transmitted from other damaged bones. Unlike basal skull fractures, vault fractures are direct in most cases.

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Despite the fact that the lower jaw is the strongest in the skull, the majority of injuries to the facial bones occur there (more than 60%). The reason for this is its mobility and placement on the internal skeleton.

Injuries to the upper jaw and nasal cavity occur much less frequently, although they are also recorded quite often. The arch of the cheekbones is even less susceptible to injury.

The most common patients in trauma departments are people who received bruises as a result of alcohol intoxication, who got into violent confrontations, or who were involved in an accident. The risk group also includes active people who are professionally involved in any sport.

From this it follows that the causes of fractures can be intentional attempts or accidental injuries.

The main causes of pathologies are:

injury to the head area with any object;
falling from a high point of support;
falling from a moving or stationary vehicle;
emergency situation on the road;
injury resulting from active motor functions;
anatomical pathology.

The main causes of a fracture are impact with a blunt massive object, a fall from a standing position, a blow to the head (sports injury), as well as zeal with additional acceleration given to the body.

Moreover, the type and severity of the fracture is significantly influenced by the condition of the victim before the incident - the state of his metabolism and the presence of diseases that increase bone fragility.

Depending on the type of injury, signs of a fracture may vary, but the common ones for a skull fracture are:

sharp pain that gets worse with slight movement,
loss of consciousness in most cases,
cerebral edema,
change in the shape of the skull,
respiratory failure.

Linear fractures are usually accompanied by the appearance of hematomas in the area of the orbit and mastoid process. Hemorrhage occurs in the middle ear area. The presence of these symptoms is very helpful in making a diagnosis when the lesions are not identified on the x-ray.

A fracture of the anterior cranial fossa is accompanied by bleeding from the nose, as well as the appearance of bruises in the area of the upper and lower eyelids. Sometimes subcutaneous emphysema caused by cracks in the air sinuses can be observed.

When the middle cranial fossa is fractured, damage to the temporal bone is often observed. Such fractures manifest themselves as bleeding from the ear, as they cause a rupture of the eardrum. The facial nerves are also affected.

Posterior fossa fractures involve injuries to the occipital bone area where cranial nerves are affected and vital organs are compromised. Another obvious symptom of a fracture is the leakage of cerebrospinal fluid from the nose or ear.

In cases of severe damage to the frontal bone, severe headaches indicate a concussion. The symptom of a fracture is pronounced hematomas in the frontal bone, changes in the shape of the skull, dizziness, nausea, vomiting, loss of vision, loss of consciousness.

There may be nosebleeds and swelling in the area of impact.

If the fracture is comminuted, then soft tissue damage, as well as complete or partial loss of sensation, are added to the general symptoms. In this case, part of the fragment may appear at the fracture site.

Impairments of consciousness as a result of a fracture depend on the severity of the injury and can be either short-term or long-term, when the victim falls into a coma.

In children, symptoms may not appear immediately and may not appear at all for some time. Subsequently, the child begins to lose consciousness due to sudden surges in pressure.

The effects of trauma become more noticeable at the age of 16, when the frontal lobes complete their formation. Any head injury requires a thorough examination and timely medical care.

Often victims of skull fractures are people under the influence of alcohol or drugs, which can make it difficult to identify symptoms.

Therefore, in such cases, the reason for going to the hospital for examination may be bruises, wounds and hematomas of the head and other objective evidence of damage.

The main etiological factor for damage to the temporal part of the skull is direct impact of force (for example, a blow with a heavy blunt object).

A fracture of the temporal bone occurs as a result of a blow to the temporal region of the skull with a hard object (a strong blow to the temple in a fight, a blow to the corner of furniture when falling, etc.). This bone is quite thin, so local pressure on it very often results in a fracture.

Temporal bone fractures in children

In children under one year of age, the fusion of the component parts of the temporal bone has not yet been completed; in the preschool years, the articulations are still quite weak. For this reason, and also due to increased physical activity in children, temple fractures are quite common.

This is important! It is worth considering that a child’s bone density is quite low, and the nervous system is still imperfect, so head injuries can have the most severe consequences.

First aid

The main task of providing first aid is to ensure complete rest for the victim, as well as to prevent infection from entering the site of possible damage.

To do this, if there is bleeding from the ear opening, you first need to tamponade with sterile cotton wool or apply a clean and sterile bandage.

Any movement of the victim, including to the hospital, must be carried out in a supine position, ensuring complete immobility.

In the hospital itself, if increased intracranial pressure is detected, a lumbar puncture may be performed.

If you suspect a fracture, you should immediately call an ambulance. If the victim’s condition is satisfactory and he is conscious, then he should be placed on his back (without a pillow), his head and upper body immobilized and fixed, and an antiseptic bandage applied to the wound.

If hospitalization is delayed, dry ice can be applied to the head. If there are no breathing problems, you can give the victim diphenhydramine or analgin.

In an unconscious state, the victim should be laid on his back in a half-turn position and his head should be turned slightly to the side to avoid aspiration in case of vomiting, loosen tight clothes, remove existing glasses, dentures, and jewelry. To secure the body, place a cushion of clothing or a blanket under one side of the body.

In case of acute respiratory distress, artificial respiration is performed through a mask. Cardiovascular drugs (sulfocamphocaine, cordiamine), glucose solution, Lasix are administered.

In case of heavy bleeding and a sharp drop in pressure, Lasix is replaced with intravenous administration of polyglucin or gelatinol. During motor excitation, a solution of suprastin is injected intramuscularly.

Painkillers should be used with caution as they may complicate bleeding. The use of narcotic painkillers is contraindicated; they aggravate respiratory disorders.

We strongly advise parents whose children have suffered a head injury: even if, in your opinion, nothing bothers the baby, he fell from a small height, stopped crying, etc., immediately seek help from the following doctors: a pediatric neurologist, a traumatologist, a neurosurgeon.

To do this, you need to call an ambulance at home and you and your child will be taken to a specialized hospital. Or, go to the emergency surgery department of any large children's hospital yourself, where the child will be consulted by the specified specialists.

If they do not confirm the pathology, you can safely return home.

Timely and correct provision of first aid is the key to successful treatment. As a rule, if the temporal bone is damaged (right or left), it consists of applying a sterile bandage to the auricle and immediately hospitalizing the victim in a hospital with a neurosurgery department.

Before the ambulance arrives, the patient must be laid on a flat surface and completely immobilized. There is no need to independently give the victim analgesic drugs, since their prescription may hide the true clinical picture of the disease.

In order to help the victim you need to:

Place the victim on a hard surface. Please note that you do not need to place a pillow or a homemade cushion under your head. Do everything as carefully as possible so as not to further harm the patient. He must be absolutely motionless to avoid worsening the situation and increasing the injury;
In case of an open fracture, it is necessary to stop the bleeding. To do this, you need to tamponade the ear canal using cotton wool. Then you should apply an antiseptic bandage to this place;
If the fracture is closed, then gently apply ice or something cold to the injury. For example, you can simply dampen a rag in cold water;
If the victim is unconscious, he should be carefully placed on his side. Then possible vomit will not enter the respiratory tract and the victim will not suffocate;
Call an ambulance as quickly as possible. Or take the patient to the doctor yourself. However, please note that the victim is transported lying on his back, while his body must be completely motionless. If you cannot provide such transportation, it is better to wait for the ambulance to arrive.

Please note that when providing first aid, it is prohibited to try to wash an open wound or instill any medications or painkillers into the victim’s ear. Timely and quickly provided first aid will help minimize the negative consequences of injury.

The consequences of such a fracture include headaches, partial or complete hearing loss, and frequent dizziness.

After the victim is taken to the hospital, his condition is stabilized. After this, the operation will be performed.

During the entire period of treatment and after it, any head bruises or concussions should be avoided. It is not uncommon for the situation to be complicated by infection in an open wound.

Therefore, it is so important to call an ambulance as quickly as possible and begin providing first aid.

First aid for a fracture of the base of the skull should be provided within 10 minutes. If a person is conscious and able to communicate with others, he must be placed on a stretcher on his back so that his head is on the same plane as his body.

If possible, give the victim an antiseptic dressing.

If a person has lost consciousness, place him on a stretcher so that the body is half a turn to one side. In order to secure the torso, place a cloth folded several times under the victim’s back.

Also turn your head to the side so that during a bout of vomiting the person does not suffocate (the airways are not blocked).

Try to unfasten clothing that may restrict the injured person's movements or interfere with free breathing. Remove his glasses and dentures (dentures).

Providing first aid for skull fractures is a very important component of all subsequent treatment. While waiting for the ambulance to arrive, the victim must be placed on his back if he is conscious. In case of loss of consciousness, the patient is placed in a half-turn position.

First aid involves applying a sterile bandage to the head and transporting the patient to the nearest medical facility.

In a hospital setting, surgical treatment is performed only in the presence of an open craniocerebral injury or hematoma in the cranial cavity. Primary surgical treatment of the wound, reposition of bone fragments, removal of tissue detritus and foreign bodies are performed. If necessary, intracranial hematomas are opened and pumped out.

Damage to the structures of the middle ear and eardrum is eliminated after the relief of life-threatening conditions. In the case of a long period without therapeutic measures, a decrease and loss of hearing is possible. When there are no indications for surgical intervention, patients are prescribed drug therapy, which consists of:

Combating cerebral edema with osmotic diuretics;
Relief of neurological symptoms, neuroprotection. It is carried out by introducing B vitamins, nootropics, neuroprotectors;
Analgesic therapy using narcotic and non-narcotic painkillers;
Symptomatic elimination of nausea and vomiting with centrally acting antiemetics;
In case of inappropriate or violent behavior on the part of the patient, sedatives are used in the form of benzodiazepine tranquilizers or sleeping pills of the latest generation.

Later, after discharge from the hospital, the patient is registered with a neurologist; symptomatic therapy is carried out in case of chronic headaches, nervous system disorders or damage to the cranial nerves.

If the victim has a pronounced cosmetic defect, then during the first 3-6 months after the injury the highest quality surgical restoration of the correct forms of the temporal region is possible.

Delaying plastic correction will lead to the formation of rough scars and bony outgrowths, making subsequent cosmetic interventions difficult.

In case of a closed fracture of the temporal lobe, it is necessary to provide the victim with maximum rest and, if possible, take him to a medical facility. You can apply a cool, damp towel to your head.

This is important! Under no circumstances should you heat your ear or put anything in it if you have a temporal bone injury!

In the case of an open fracture, you should not wash the wound, as this action can contribute to infection and subsequent complications. If possible, apply a sterile dressing to the wound and take the victim to the hospital. If the patient is unconscious, you need to call an ambulance to transport him.

Diagnostics

An important examination for head trauma in infants is neurosonography - a study of the structure of the brain using an ultrasound machine through the child’s large fontanel (such a study is possible until the large fontanelle closes, up to 1 - 1.5 years).

This method is easy to use, does not have a negative effect on the body, and provides enough information to determine treatment tactics for the patient. With its help, you can first of all exclude or determine the presence of intracranial hemorrhages (the most life-threatening).

The only limitation to its use may be the absence in the hospital of an ultrasound machine or a specialist who knows how to operate it (for example, not all hospitals in the country that have ultrasound machines can conduct emergency neurosonography at night, since the specialist works during the day).

The presence of intracranial hemorrhage is determined by the presence of blood cells in the cerebrospinal fluid.

In addition, there are more complex methods for examining the child’s head: computed tomography (CT) and magnetic resonance imaging (MRI).

Computed tomography (CT) (from the Greek tomos - segment, layer in Greek.

grapho - write, depict) is a research method in which X-rays are used to obtain images of a certain layer (section) of the human body (for example, the head). With CT, the rays hit a special device that transmits information to a computer, which processes the received data on the absorption of X-rays by the human body and displays the image on the monitor screen.

In this way, the smallest changes in the absorption of rays are recorded, which in turn allows you to see what is not visible on a regular x-ray. It should be noted that radiation exposure with CT is significantly lower than with conventional X-ray examination.

Magnetic resonance imaging (MRI) is a diagnostic method (not associated with x-rays) that allows you to obtain layer-by-layer images of organs in various planes and construct a three-dimensional reconstruction of the area under study.

It is based on the ability of some atomic nuclei, when placed in a magnetic field, to absorb energy in the radio frequency range and emit it after the cessation of exposure to the radio frequency pulse.

For MRI, various pulse sequences have been developed to image the structures under study to obtain optimal contrast between normal and altered tissues. This is one of the most informative and harmless diagnostic methods.

But the widespread use of CT and MRI in early childhood is difficult due to the need to conduct this examination in children in a state of immobility (under anesthesia), since an important condition for the successful implementation of the technique is the immobility of the patient, which cannot be achieved from an infant.

After receiving a trauma to the temporal region, it is necessary to make a timely and correct clinical diagnosis. To do this, the specialist needs to see a complete x-ray picture (CT is a study that uses x-rays) of the conditions of the bone structures.

The use of an x-ray diagnostic method in this situation is inappropriate, since this study does not allow the doctor to see the area and line of the fracture of the temporal bone pyramid and assess the severity of the disease itself.

In this situation, a computed tomography scan is necessary. This method is based on layer-by-layer visualization of bone structures using x-rays.

If there is a traumatic injury to the base of the skull, a diagnosis must be made as soon as possible and symptomatic treatment must begin. MRI, on the contrary, is prescribed for visual assessment of the condition of soft structures (cerebral hemispheres, brain stem, cerebellum, etc.).

To make a diagnosis, the craniography method is used (x-ray examination of the skull without the use of a contrast agent). In some cases, cracks may extend through several bones.

When studying the images, special attention should be paid to the intersection of the vascular grooves by the crack, since this can damage the intracranial vessels and meningeal arteries, which causes the formation of epidural hematomas.

Sometimes the edges of the hematoma can be compacted and raised, which creates the impression of a depressed fracture upon palpation.

Sometimes in medical practice there are mistakes when the shadow of a vascular groove is mistaken for an incomplete fracture (crack). Therefore, it is necessary to take into account the location of the arterial grooves and the specifics of their branches. They always branch in a certain direction, their shadows are not as sharp as fracture lines.

A linear fracture on an x-ray has the following distinctive features:

The fracture line is black;

The fracture line is straight, narrow, without branching;

The vascular groove is gray, wider compared to the fracture line, tortuous, with branching;

The cranial sutures are gray in color and of considerable width, with a standard course.

8-10 days after a TBI, cracks in the bones are more clearly visible than immediately after the injury.

The first examination that needs to be done if a temporal bone fracture is suspected is a computed tomography scan of the brain. X-rays are performed later. An examination by a neurologist is required to possibly detect paresis of the facial muscles.

Performed on patients:

audiometry;
checking the functions of the vestibular apparatus;
tuning fork tests by Rinne and Weber to determine the nature of hearing loss: conductive or sensorineural.

The exact diagnosis of “temporal bone fracture” and the type of damage are established after a thorough X-ray of the temporal region in at least three projections. In particularly difficult cases, it is necessary to resort to computed tomography.

Having received such a fracture, it is necessary to be treated only inpatiently, under the continuous supervision of doctors. To treat a longitudinal fracture, therapy in three directions is most often sufficient:

bleeding or liquorrhea;

The ear is cleaned “dry”, using a cotton holder or a suction device. After cleaning, a sterile bandage is put on, which cannot be removed day or night. During the normal course of recovery, the discharge stops within a few days.

Conservative therapy is generally indicated, and surgery is performed only in the most severe cases and only after the symptoms of a concussion or brain injury have been eliminated. During the treatment process, it is important to exclude the development of secondary complications, so the patient is often prescribed antibacterial therapy, which will help eliminate cerebral edema.

It is important to understand that the treatment of a temporal bone fracture is determined by the doctor individually for each patient, based on the severity of the disease.

The diagnosis of a “temporal bone fracture” is made by a doctor based on anamnesis, examination, and the results of instrumental studies. In order to get a clear picture of the disease, the doctor prescribes an X-ray examination, as well as magnetic resonance imaging or computed tomography.

The diagnostic results will allow us to determine the degree of damage and develop therapeutic therapy.

If you receive an injury such as a skull fracture in the temple or other area, you must provide first aid to the victim and call an ambulance. After the patient is taken to a medical facility, treatment will begin.

First of all, a person with a skull fracture is examined and all necessary actions are taken to restore his condition. After the victim’s condition has stabilized, he is sent for diagnostics.

In emergency cases, diagnosis is carried out while the patient is being prepared for surgery.

Diagnostics includes a number of laboratory and hardware tests:

general tests;
X-ray;

To establish a complete clinical picture, consultation with several doctors of different specialties may be required. Only after the general picture of the pathology has been established is the method of eliminating it determined.

Treatment methods

Depending on the area of injury, as well as the complexity of the fracture, treatment can be carried out using different methods. Head trauma is a serious pathology, therefore, in most cases, surgical intervention is performed for fractures.

This type of operation is dangerous for children and adults. An elderly person with a traumatic brain injury does not undergo surgery due to the high risk.

In some cases, conservative treatment is allowed. It is mainly used if subluxation of the temporomandibular joint is diagnosed.

Treatment of a temporal lobe fracture

In case of a fracture of the temporal bone, it is very important that the victim receive first aid, which will consist of applying a sterile bandage to the ear, as well as urgent transportation to the hospital, or rather to the intensive care unit or neurosurgical department.

It is important to understand that after receiving an injury, it is strictly forbidden to rinse the auricle or instill any drops. After admission to the hospital, treatment can be carried out conservatively or surgically.

Conservative therapy is generally indicated, and surgery is performed only in the most severe cases and only after the symptoms of a concussion or brain injury have been eliminated.

During the treatment process, it is important to exclude the development of secondary complications, so the patient is often prescribed antibacterial therapy, which will help eliminate cerebral edema.

It is important to understand that the treatment of a temporal bone fracture is determined by the doctor individually for each patient, based on the severity of the disease.

The diagnosis of a temporal bone fracture is made on the basis of anamnesis, an objective examination of the patient and an x-ray picture. The fracture line of the temporal bone is not always visible on x-rays.

In this case, it is necessary to take pictures of the bone in other additional projections - lateral, medial and oblique. In some cases, to clarify the diagnosis, it is necessary to consult a neurologist, an ENT doctor, and conduct a computed tomography scan.

When examining a patient, the attending physician must make a differential diagnosis between the symptoms of infectious or non-infectious (reactive) meningitis. Even a small subarachnoid hemorrhage can cause symptoms of reactive meningitis.

In this case, when receiving the results of a cerebrospinal fluid analysis, you can see an admixture of “old blood” or “leached” red blood cells, which indicate hemorrhage has occurred in the structures of the brain.

The most informative method for diagnosing bone fractures is radiography. Due to the structural features of the temporal bone, for an accurate diagnosis it is necessary to perform fluoroscopy in 3-4 projections. It is also possible to conduct an MRI, and laboratory tests of blood and leaking cerebrospinal fluid are prescribed.

Features of treatment

Once a temporal bone fracture is identified, the patient is usually prescribed conservative treatment. However, if a concomitant concussion or brain contusion or an infectious complication is detected, the following methods can be performed:

carrying out antibiotic therapy;
dehydration therapy;
surgical intervention to eliminate mechanical damage in case of a fracture of the temporal bone pyramid;
Schwarze operation or extended mastoidotomy (trepanation of the mastoid process to remove damaged bone tissue).

Treatment tactics are based on the patient’s individual complaints and a complete picture of the bone structures obtained after a computed tomography scan.

Surgical treatment

Surgical treatment is performed when conservative therapy is ineffective. In most situations, an extended matoidotomy or Schwartze operation is used.

When performing this operation, local anesthesia is used to control the patient's condition during cutting of the bridge, since paralysis of the facial muscles may develop due to damage to the facial nerve.

The Schwarze operation is indicated for patients with a typical clinical picture of matoiditis. The main goal of this surgical intervention is to eliminate the purulent-destructive process in the mastoid area and parallel drainage of the tympanic cavity.

Where is TBI treated?

According to existing rules (standards), all children with traumatic brain injury must be hospitalized. Children with a concussion (mild traumatic brain injury) can be treated in the neurological and neurosurgical departments.

Patients with more severe forms of injury should be treated in a neurosurgical department (if one is available in a particular region).

Carrying out justified, targeted treatment requires a comprehensive examination of the child, which is only possible in a hospital.

This examination includes thorough examinations of the nervous system, vestibular system, organs of vision, hearing and other studies.

In the emergency department, the child is examined, signs indicating damage to the skull bones or brain injury are identified, the parents are asked about the child’s condition after the fall, etc.

TBI treatment tactics

After the examination and clarification of the diagnosis, treatment tactics are determined. Drug treatment is prescribed (therapy aimed at eliminating cerebral edema, lowering intracranial pressure, correcting metabolism and blood flow in the brain, etc.).

Surgical treatment is used (and necessary) primarily to eliminate compression of the brain. It is prescribed to children with depressed fractures of the skull bones and intracranial hemorrhages.

Parents need to realize that only a comprehensive, adequate examination of the child allows for correct and timely treatment of brain injury, achieving recovery and avoiding disability.

How to reduce the likelihood of a TBI

Injuries in children most often occur in the presence of adults, and this once again indicates our inattention or frivolity and carelessness, as well as the fact that we have a poor understanding of the motor skills of the baby. Parents should anticipate the development of new motor skills in the child and take safety measures.

So, a month-old baby, lying on his stomach, can push off with his feet from the side of the changing table, from the back of the sofa, bed and fall. Each subsequent skill or movement of the baby (attempts to sit, crawl, stand) can also lead to “unexpected” injuries.

A child, trying to get up, may fall out of the stroller or high chair, especially if they forgot to fasten it.

If you need to move away, do not leave the child alone lying on any high (or not very high) surface, put the baby in a crib, playpen or even on the floor.

Fasten your child in a high chair and stroller.

If there are stairs in the house, install a safety fence so that your child cannot fall down or climb high and then fall.

“Walkers” can also be unsafe: children, while in them, can push off strongly, hit something, roll over, and also fall down the stairs. It is better to avoid using such a vehicle.

“Jumpers” are dangerous due to the unpredictability of the trajectory of movement: for example, a child in them can collide with a wall.

The most important role in reducing childhood injuries is given to prevention, and the main thing in it is the attentive attitude of adults towards children and their safety.

Orest Gaevy, neurosurgeon, associate professor of the Department of Pediatric Neurosurgery of the Russian Medical Academy of Postgraduate Education