Comminuted fractures of the skull bones are formed during exposure. Fracture of the base of the skull: symptoms, survival, consequences

A calvarial fracture is a very severe one, which is characterized by damage to the bone structure of the skull. 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

Cranial vault fractures cause a tear in the dura mater. 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 head injuries. 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 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 a patient is diagnosed with a temporal bone injury, then the apex may be torn off and ruptured. eardrum. This will lead to sharp deterioration hearing and the appearance of bruises in the mastoid area.

A fracture of the temporal bones occurs with a strong blow to the occipital part of the head and is characterized by damage facial nerve. Moreover, the work is disrupted vestibular apparatus and there is a loss taste sensations.

When the cranial fossa located in front is injured, nasal liquorrhea and severe nosebleeds occur. 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 of the frontal bone and into the ethmoid septa. When the occipital part is damaged, the caudal group of nerve endings is damaged, which impedes the functioning of the entire organism.

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. An open wound should be treated with antiseptics and a loose bandage applied.

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 artificial respiration is performed. 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 is agitated 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 relieve painful spasms and stop 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 can be influenced by various pathologies that appear as a result of traumatic infection of soft brain tissue. When diagnosing a fracture without bone displacement, which does not cause purulent formations, the probability of a favorable outcome is very high.

If complications develop infectious nature(meningitis, encephalitis, etc.), then, most likely, the person will develop encephalopathy and uncontrolled surges in blood pressure in the future. 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 undergo periodic lumbar punctures. In this case, 30-40 ml of cerebrospinal fluid should be infused, subarachnoid insufflation and not a large number of oxygen. 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 abscesses, 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 conservative treatment. Similar treatment will help reduce intracranial pressure and normalize brain function.

A calvarial fracture is a serious injury that is characterized by a violation of the integrity of the bones of the skull that form it top part, i.e. vault. In injury statistics, skull fractures account for up to 8% of all types of fractures. Such an injury is complex and can cause the victim's death due to compression or damage to the brain.

The cranial vault or its upper part forms several bones of the skull at once. These bones include: parietal, frontal and occipital bones.

The parietal bone is paired and forms a sagittal or sagittal bone suture in the projection of the midline of the body. The front arch is formed frontal bone, and behind the occipital bone. The connection of the frontal bone with the parietal bones forms the coronal or frontal bone suture. Compound occipital bone forms a lambdoid suture with the parietals. It is important to note that all the bones of the cranial vault have a spongy structure, that is, they consist of two plates of compact bone substance, and in the middle they have a porous structure.

Causes of fracture

A calvarial fracture can occur due to many reasons, however, there are only two mechanisms for the formation of a calvarial fracture:

direct damage. With a similar mechanism, an impact occurs in the head area, as a result of which a section of bone is pressed into the cranial cavity;
indirect damage. The place of impact is at large area, and the damage is detected on the cranial vault.

Most calvarial fractures occur either as a result of blows to the head with heavy blunt objects with a small contact surface area, or as a result of a car accident or other traffic accidents, falls with impacts on a hard object. The mechanism can be any, the main thing is that the strength of the damaging factor is greater than the bone density. Fracture of the skull vault, photo.

Classification

To determine the management tactics for a patient diagnosed with a fracture of the calvarial bones, it is necessary to accurately determine the nature of the fracture.

Based on the nature of the fracture, we can distinguish the following types:

Linear fracture. The bone tissue is damaged in the form of a thin line; roughly speaking, the fracture resembles a crack in a lamellar bone. A linear fracture is one of the best options and has minimal risk development serious complications, however, there is still a risk of damage to those adjacent to the inner plate cerebral arteries, which may lead to the development of an epidural hematoma of the brain;
depressed fracture. Occurs as a result of the first mechanism of injury. In this case, the inner plate undergoes deformation and is pressed into the substance of the brain. This situation can lead to rupture of the dura mater and injury to the cortex. cerebral hemispheres and cerebral vessels. A depressed fracture can lead to crushing of the brain substance, the occurrence of massive subdural hematomas with the phenomenon of brain dislocation;
comminuted fracture. This type of calvarial fracture occurs with the strongest blows to the skull. When a fracture occurs, a large number of broken bone fragments are formed. As a rule, the fragments have very sharp edges and easily damage the meninges and the brain itself. The consequences of a comminuted fracture are similar to depressed fractures;
a separate type is a perforated fracture. Damage occurs when a small object impacts a bone. An example would be a gunshot fracture or being hit by an object with a pointed end. In this case, a bone defect of various diameters occurs and the substance of the brain and its membranes is almost always damaged.

Symptoms of a skull fracture

When a fracture of the calvarial bones occurs, a number of syndromes arise that form a characteristic clinical picture. Symptoms of a calvarial fracture include local - local in nature and general - changes in all organs and systems.

TO local symptoms may include a visually detectable hematoma or rupture skin at the site of direct impact. With significant fractures, deformation of the skull is determined. The victim may also bleed.

TO cerebral symptoms There are quite a large number of signs that allow us to judge the severity of the victim’s condition. Strong headache, which occurs at the time of injury and does not go away when taking analgesics. The victim may experience nausea and dizziness; in severe cases, vomiting may occur, which does not bring relief. With the most severe fractures of the cranial vault, the patient loses consciousness and may even fall into coma.

When determining the vital functions of the victim, uneven pathological breathing is noted, most often of a superficial nature. Arterial pressure can be significantly reduced, the pulse becomes barely perceptible, thread-like. If the substance of the brain is damaged, paralysis of the motor muscles may occur. The patient's condition directly depends on the presence of hemorrhage and cerebral edema. When edema or hemorrhage occurs, intracranial pressure increases significantly, which can subsequently lead to brain dislocation and depression of vital functions, such as cardiovascular and respiratory activity.

Diagnostics

The occurrence of a fracture of the cranial vault does not cause difficulties in diagnosis, however, establishing the severity of the fracture and the presence or absence of serious brain damage is possible only with the help of special diagnostic studies. To confirm the diagnosis of a calvarial fracture, a standard diagnostic complex is necessary. The examination begins with collecting a history of the disease. It is very important to find out how long ago the injury occurred, since a number of patients develop a condition called lucid interval. During the light interval, the victim’s condition remains stable, despite the damage, however, often the light interval is an unfavorable prognostic sign.

The doctor must examine the pupil and check reflexes, which helps determine topical diagnostics for damage various departments central nervous system. It is mandatory for the victim to undergo an X-ray of the head in two projections, which helps confirm the diagnosis of a fracture of the cranial vault. To clarify the location of fragments and draw up an accurate plan for surgical intervention, the diagnosis is supplemented computed tomography. To determine the extent of damage nerve tissue Magnetic resonance imaging and positron emission tomography of the brain are used.

Treatment

Treatment tactics will depend on the type of fracture and the severity of the brain damage. Linear fractures are the easiest to treat. Such an injury is considered closed, i.e. the integrity of the dura mater is not violated, which means that the risk of an infectious process in the nervous tissue of the brain is minimal. For the treatment of a linear fracture of the calvarium, primary surgical treatment wound surfaces scalp. Then hemostasis (stopping bleeding) and suturing of the wound are performed.

Things are more complicated if the skull fracture is depressed or comminuted. Depending on the area of the bone defect, reconstructive surgery may also be required. Plastic surgery using a titanium or polymer implant. In case of injury to the dura mater and significant hemorrhage, they resort to stopping the bleeding, removing the subdural hematoma and suturing the skin defect of the scalp. The victim must be prescribed accompanying antibacterial therapy to reduce the risk of developing meningitis or encephalitis.

For a closed type fracture with traumatic brain injury there is high probability development of cerebral hematoma and cerebral edema. Which will inevitably lead to an increase intracranial pressure and further fatal outcome. To prevent compression of brain tissue by edema or hematoma, they resort to brain decompression. The patient is taken to the emergency operating room and decompressed by placing burr holes in the head. Trepanation avoids brain dislocation and development of herniation medulla oblongata into the foramen magnum.

In case of a perforated fracture or pressure of fragments into the cranial cavity, it is indicated surgical treatment in the form of decompression trepanation. It is carried out in the operating room and its essence is to remove fragments and make a hole in the skull vault; it can be of different diameters. The doctor uses special nippers to bite out a section of the bone, allowing edematous brain tissue to escape into the hole. The defect is later closed with a special plate when the threat to life disappears. This type of surgery is called decompression trephination according to Cushing.

Decompression trephination according to Cushing

In addition to surgical treatment, the victim must be in the intensive care unit on the first day, where all vital signs are monitored. important functions until your health condition stabilizes. Monitoring is carried out respiratory system, saturation, systemic hemodynamics, blood coagulation system. Must be controlled daily diuresis and water and electrolyte balance, so as not to miss the development of cerebral edema. Powerful antibiotic prophylaxis is carried out to avoid the development of severe infectious processes in the brain, and neuroprotective drugs are also used.

On average, a patient diagnosed with a calvarial fracture remains in hospital for 15 days to 1.5 months, depending on the severity of the health condition. In severe cases, the victim may remain in a coma for up to several days while the central nervous system will not begin to adapt to damage.

Consequences

If medical care is not provided in a timely manner, the consequences of a skull fracture can be very disastrous. The most formidable complication– development of cerebral edema and herniation of the medulla oblongata into the foramen magnum. In this case, vasomotor and respiratory centers, located in it, which inevitably leads to death.

If the nervous tissue is seriously damaged by shrapnel, the victim may develop skeletal muscle paralysis, which leads to profound disability. In the long term after the injury, the patient may experience changes in character and behavior. Often patients begin to experience epileptic seizures.

Among injuries with high mortality, fracture of the base of the skull is considered one of the most common. As a result of damage bone structures such an important organ as the brain suffers. Often a fracture of the base is accompanied by damage to the cranial vault. What is the outcome of such a wound is best told by statistics - they lead to death in 20% of cases. Survival from a basal skull fracture is directly related to the complexity of the injury and the age of the victim. over the age of 50 years are more likely to result in death.

Damage such as a skull fracture can only be caused by strong impact. The bones of the head are highly durable, and they cannot be damaged under any circumstances.

When closed injury survival rate is higher. The classification of skull fractures allows us to distinguish several types of injuries:

linear– the least dangerous damage without displacement. A linear skull fracture implies a crack of clear geometry. It is possible that the integrity of the meninges is damaged, but the prognosis is favorable compared to other injuries;
comminuted- can be closed or open. The latter occur more often and are accompanied by polytraumas. Of particular danger is brain crushing;
dented– the presence of multiple fragments is not necessary, but a depressed skull fracture is dangerous because part of the bone tissue penetrates into the skull. An impression fracture of the skull is often fatal;
breakdown- they account for the most large percentage mortality. Perforated skull fractures are characterized by penetrating injuries. The characteristics of the entry hole provide clues as to how the injury was caused. Most often this is a gunshot wound.

It is not always possible to unambiguously establish the type of skull fracture, since various disorders. Thus, a comminuted fracture of the skull is accompanied by damage to the optic nerve, organs of vision and hearing, and bone structures of any location. In this regard, injuries are classified according to the location of the cranial fossa:

front– single fractures of the anterior cranial fossa are less common;
average– fractures of the middle cranial fossa account for 60% of total skull injuries;
rear– with fractures of the posterior cranial fossa, concomitant disorders of the bone tissue of other organs are observed, for example.

Trauma to the base of the skull, that is, a basilar fracture, is accompanied by cases of scalping of the skull. If the cause of the damage is compression, then comminuted fractures are observed. A depression fracture of the skull is one of the varieties of depressed fracture.

The mechanism for the formation of such an injury is as follows: an object with enormous impact force and a large contact area hits the base of the skull. Such damage is typical for frontal sinus And temporal region, where the structures are thinner. When an old wound is re-injured, a terrace-shaped fracture occurs - the fragments are arranged in a stepwise order, which is why the injury got its name.

Trauma code according to ICD 10

By international classification disease code for cranial injuries – S02. A skull fracture is determined by the location of the injury. Thus, vault injury is indicated by code S02.0, – S02.3. A direct fracture of the base of the skull according to ICD 10 is coded S02.1. Additional numbers after the main code indicate the nature of the fracture - open or closed.

Causes

Fractures of the skull bones usually occur in accidents. In the event of an accident, a strong impact occurs with a large surface area. Not only the head suffers, but also other organs. The risk group includes representatives of motorcycling and cycling.

One of the most common reasons Child injury is a fall from a height. In infants, uncomplicated fractures of the bones of the skull base are the result of falling out of a stroller or from a changing table. But usually such an impact is not enough to severely damage bone tissue.

A fracture of the base of the skull is caused by impact with a blunt object great strength. A falling beam or log causes a fractured skull. With such an injury, death may occur immediately after impact. If the victim received a minor blow, a crack will occur. Due to damage to the skull, dizziness and loss of orientation occur.

How else can you get a skull injury? It is difficult to break a skull during a fight. But if you hit the face with a heavy object, then cracks in and temporal zone. In such cases, a dissection of the eyebrow or. The nasal passage is destroyed, the eye sockets are injured, bone fragments can disrupt the functions of important organs. How hit harder, those more likely comminuted fracture.

The most dangerous injury is caused by compression of the skull. This occurs in car accidents when the victim is pinched between vehicles. During combat operations, shrapnel and gunshot wounds occur. If the meninges are damaged, the probability of death is high. When a bullet wound occurs, brain fluid leaks out through the hole and brain tissue dies.

Symptoms

Signs of a skull fracture are lack of consciousness or disorientation of the victim. If a person is conscious, he will complain about unbearable pain. Vision and hearing may be impaired due to damage to the olfactory or optic nerve. Due to brain swelling, breathing is impaired, pressure on the eyes causes multiple hemorrhages. If blood vessels burst, the whites of the eyes turn completely red. A symptom of glasses also occurs - hematomas around the eyes.

At the same time it is observed a sharp decline hearing loss, bleeding from the ears. Symptoms of a skull fracture include facial paresis, abnormal reflexes, and motor abnormalities. The patient begins to vomit, the pulse weakens, convulsions and other atypical reactions occur.

Symptoms of a fracture of the base of the skull include nasal discharge of an unclear nature. This could be cerebrospinal fluid. The functioning of the vestibular apparatus is disrupted, consciousness is confused. TO typical manifestations Fractures of the base of the skull include different pupil diameters, loss of taste, cardiac dysfunction, and spontaneous urination.

If a person does not have characteristic signs of injury, but has open wounds on the head, then a fracture should not be immediately ruled out. Injuries may be minimal, but their consequences can be dangerous. A skull fracture is rarely without symptoms, but a victim in a state of shock may not feel characteristic changes for some time.

First aid

Skull fractures are extremely severe injuries, and primary care should be performed by medical professionals. the skull involves immobilization of the victim. Even turning the head can be dangerous after an injury, so unnecessary movements are excluded. However, the patient often experiences profuse vomiting, causing suffocation. If the patient is conscious, then it is necessary to lay him on his side or stomach.

Emergency first aid involves removing tight clothing, jewelry, and watches. If the victim is conscious and breathing smoothly, then it is permissible to give analgin to reduce pain syndrome. For open wounds they are carried out antiseptic treatment, avoiding sudden or violent movements.

For skull fractures with severe blood loss, painkillers are not given. Because of them, bleeding may increase. At internal hemorrhages and visible hematomas, it is allowed to apply dry cold. The rest of the treatment must be done in the clinic.

For a fracture of the base of the skull, first aid includes assistance medical workers in transporting the victim. What needs to be done is to place the patient on a hard surface and immobilize the head. Try to minimize shaking and displacement. The victim's head is held with hands until complete immobilization.

What should not be done until the ambulance arrives is to give strong painkillers. They provoke respiratory arrest.

Diagnostics

A traumatologist makes a diagnosis based on x-rays and questioning of the victim, if he is conscious. The examination is carried out on an emergency basis, since a skull fracture causes immediate complications that can lead to death. X-ray images show the location and nature of the fracture. But taking an x-ray is not always possible, so other research methods are used:

MRI – allows you to assess the condition of soft tissues in case of concussion and damage from bone fragments;
CT – more informative method rather than radiography, shows the condition of bone structures.

If hemorrhage occurs, swelling and large hematomas appear. To assess the contents of nasal discharge or other tissues of the head, a fluid sample or smear is taken. An experienced traumatologist is able to diagnose a fracture of the base of the skull even without instrumental examination. But it may be necessary differential diagnosis to determine the nature of head injuries. Treatment tactics also depend on this.

Treatment

First of all, efforts are directed toward preserving the life of the victim. Through and depressed fractures are considered the most severe, and before starting primary therapy, it is necessary to ensure the integrity of vital organs. Fractures of the skull bones take a long time to recover even in the absence of complicating factors.

In open trauma, the emphasis is on controlling infection. The wound is sanitized and the patient is given antibiotics. When closed fracture cost conservative treatment: the patient is kept at rest, placed in an elevated position to avoid leakage of brain fluid, and a cleol bandage is applied. Typically, an adhesive shingle bandage is applied for fractures of mobile joints, but for serious skull injuries it will replace the traditional circular sling.

Typical basal skull fracture lines do not require significant reduction. The main methods of treatment are adequate drug therapy. The victim is prescribed painkillers, drugs for cerebral circulation, lumbar punctures. Special meaning has dehydration therapy. With simultaneous concussion, nootropic and vasotropic drugs are indicated.

Before full recovery the patient is prescribed rest. The prognosis is favorable if the injury was not displaced and infection was avoided. At the discretion of the attending physician, they are prescribed to improve the fusion of bone tissue. They are especially needed when taking diuretics.

endonasal electrophoresis– activates blood circulation, warns hypothalamic syndrome, eliminates bruises in the affected area;
central electroanalgesia– relieves stress reactions, has a sedative effect;
galvanic collar– soothes, relieves spasms, has a local analgesic effect.

Motor development

In case of paralysis or decreased accuracy of movements, exercise therapy and treatment by a kinesiotherapist are prescribed. Massage and hardware effects on nerve endings and muscle fibers, balneotherapy. To restore motor activity, special simulators are used, classes on which are conducted in rehabilitation centers.

Acupuncture as prescribed by a doctor will relieve tremors, muscle weakness, and blood stagnation in the extremities. Alternative medicine methods will help enhance the effectiveness of classical rehabilitation programs. To activate blood circulation and improve sensitivity, hot stone massage, reflexology, and apitherapy are performed. All these methods are aimed at activating the parts of the brain responsible for motor activity.

The types of recovery methods are much similar to stroke therapy. The set of measures is selected by the attending physician and specialized specialists: neurologist, neurosurgeon, rehabilitation specialist.

Help from a psychologist

Brain injuries not only affect the functioning of all body systems, they change the personality of the victim. A previously sociable and active person can become withdrawn, depressed, and apathetic.

Changes in higher nervous activity lead to the fact that a person becomes a “stranger” to his environment. At the stage of rehabilitation with a psychologist, the victim manages to accept his changed personality and return to his previous life. Psychological practices can help with this: art therapy, group treatment, etc.

The neuropsychologist promotes the socialization of the victim. This is especially important if it was accompanied by partial or complete amnesia, previous coma, decreased mental abilities, and deterioration in imaginative thinking. With good motivation, the patient will be able to restore memory, regain speech and mental abilities.

Complications and consequences

Negative consequences after a fracture of the base of the skull appear when open injuries with offset. Extremely serious condition occurs when brain structures are damaged, and even timely medical care does not guarantee full recovery. According to statistics, patients who survive the first day after injury do not die. But this does not mean that they return to their previous life. The victim may fall into a long coma, but even after regaining consciousness, parts of the brain will not function fully.

In the case of a cerebral hematoma, compression of the soft tissue occurs. This is another reason why patients fall into a coma. The condition is dangerous because brain tissue may die.

Infectious diseases often lead to encephalitis and meningitis. These consequences of a fracture of the base of the skull are the most difficult to treat. In case of purulent complications, repeated trephination has to be performed. Another intervention threatens to deteriorate brain function even with successful treatment.

Sometimes complications arise over a period of time, which is associated with the period of formation of new bone tissue in places of cracks. Problems may occur up to 5 years after the injury. Typical consequences include:

convulsions and epileptic seizures;
mental disorders;
cerebral hypertension with risk of stroke;
paresis and paralysis of the limbs;
problems with vision, hearing, attention;
partial or complete amnesia;
migraines, headaches when the weather changes;
pressure surges.

It often occurs, back pain appears, joint diseases and osteochondrosis progress. Hearing problems often occur. If the structures in the middle ear cavity have been damaged, hearing cannot always be restored. It is interesting that during the period of injury they go unnoticed due to the vivid symptoms of TBI. When bone the skull is restored and the pain goes away, problems with the hearing organs become obvious.

The lifestyle of a patient after a TBI must change. To maintain brain health and performance, you should completely abandon bad habits and periodically take medications to improve cerebral circulation. Throughout his life, a person has to be observed by a doctor and undergo courses of maintenance therapy. Unfortunately, only 50% of trauma survivors can return to normal life.

Dear readers of the 1MedHelp website, if you still have questions on this topic, we will be happy to answer them. Leave your reviews, comments, share stories of how you experienced a similar trauma and successfully dealt with the consequences! Your life experience may be useful to other readers.

Author of the article:| Orthopedic doctor Education: Diploma in General Medicine received in 2001 medical academy them. I. M. Sechenov. In 2003, she completed postgraduate studies in the specialty “Traumatology and Orthopedics” at the City clinical hospital No. 29 named after. N.E. Bauman.

Fractures of the base of the skull are among the most dangerous and severe injuries. They are more often observed in leading active image the lives of young or middle-aged people and socially disadvantaged people. These injuries account for 4% of the total (traumatic brain injuries).

The causes of such fractures can be direct blows to lower jaw or to the head, road traffic accidents, sports (especially extreme sports), falls from a height, industrial accidents, etc. In this article we will introduce you to the types, symptoms, methods of providing first aid, treatment methods and consequences of such injuries . This information will be useful to you, and you will be able to provide the necessary assistance to the victim in a timely and correct manner, increasing his chances of recovery. favorable outcome fracture

With such injuries, a fracture of the occipital, sphenoid, ethmoid or temporal bone occurs. The danger of these injuries lies not only in broken bones, but also high risk violation of the integrity of nearby organs. The close location of such important organs for ensuring vital functions as the head and spinal cord, determines the inclusion of such fractures in the emergency response list, since their occurrence almost always poses a threat to life. A fracture of the base of the skull may be self-inflicted injury or combined with damage to the bones of the arch (approximately 50-60% of cases).

Classification

By their nature, fractures of the cranial vault are divided into:

linear - the bone fracture is a thin line and is not accompanied by displacement of fragments, such injuries are the least dangerous, but may be accompanied by the appearance of epidural hematomas and damage to the vessels of the meninges;
splintered - when a fracture occurs, several fragments are formed that can injure the membranes and tissues of the brain (brain crush, subdural and intracerebral hematomas);
depressed - the fragment is pressed (immersed) into the cranial cavity and causes the same damage as a comminuted fracture.

Based on location, such injuries are divided into fractures:

anterior cranial fossa;
middle cranial fossa;
posterior cranial fossa.

According to various statistics, in 50-70% of cases fractures occur in the area of the middle cranial fossa. Depending on the nature of the fault line, they can be transverse, longitudinal or oblique.

Mechanisms of damage

Fractures of the bones of the base of the skull are in almost all cases accompanied by rupture of the dura mater of the brain. In this case, communication occurs in the mouth, nose, paranasal sinuses nose, middle ear and eye socket with air external environment. It can lead to the entry of microbial agents and infection of brain tissue, the appearance of post-traumatic pneumocephalus and leakage. cerebrospinal fluid from the ears and nose (auricular and nasal liquorrhea).

With fractures of the anterior cranial fossa, hemorrhage occurs in the tissue of the periorbital tissue (“symptom of glasses” or “raccoon eyes”). When the perforated plate and cells of the ethmoid bone are broken, cerebrospinal fluid may leak through the nose and in some cases subcutaneous emphysema develops.

With some fractures of this part of the skull, damage to the visual, oculomotor and olfactory nerves. Such injuries may be accompanied by concomitant injuries to the diencephalic parts of the brain.

Symptoms

The severity and nature of symptoms in fractures of this part of the skull depend on the location of the fracture and the degree of damage to the brain structures. At the time of injury, the victim loses consciousness. Its duration depends on the severity of the damage - it can be expressed in momentary fainting or prolonged coma. When forming intracranial hematoma There may be a short period of lucidity before loss of consciousness, which should not be taken as a sign of minor injury.

Common signs of a basal skull fracture are the following:

bursting, arising due to progressive cerebral edema;
"symptom of glasses";
different pupil diameters;
pupils do not react to light;
vomit;
nasal or ear liquorrhea (with blood);
involuntary urination;
disorders of the heart: slowing or increasing heart rate, arterial hypo- or hypertension;
confusion;
agitation or immobility;
circulatory and respiratory disorders (due to compression of the brain stem).

Fractures of the pyramid of the temporal bone

With such injuries, faults can be longitudinal, transverse, diagonal, and with apical separations. A transverse fracture provokes paralysis of the facial nerve, disturbances in the functioning of the vestibular apparatus, and complete loss of hearing and taste. With longitudinal fractures, the facial nerve canal, inner and middle ear are damaged. In this case, partial hearing loss, rupture of the eardrum, bleeding and leakage of cerebrospinal fluid from the ear, hemorrhage in the area of the temporal muscle and behind the ear develop. When you try to turn your head, the bleeding becomes more intense. Therefore, such victims are strictly forbidden to turn their heads.

Anterior cranial fossa fractures

Such injuries are accompanied by nosebleeds and nasal liquorrhea. After 2-3 days, the “symptom of glasses” appears. When the cells of the ethmoid bone are broken, subcutaneous emphysema develops and blisters form on the skin.

Middle cranial fossa fractures

Such injuries are accompanied by the development of unilateral auricular liquorrhea, which develops as a result of rupture of the eardrum, and unilateral bleeding from the ear. The victim's hearing sharply decreases or disappears completely, bruises appear in the area of the temporal muscle and behind the ear, the functions of the facial nerve and taste sensations are disrupted.

Posterior fossa fractures

With such fractures, the victim develops bruises behind one or both ears, and there are disturbances in the functions of the facial, abducens and auditory nerves. The functioning of vital organs of the victims is disrupted. When the caudal nerves are ruptured or pinched, paralysis of the tongue, larynx and palate develops.

First aid

The outcome of such injuries largely depends on the correct provision of first aid. If you suspect such damage, you should immediately call an ambulance. After this, the following activities must be carried out:

Place the victim on his back without a pillow. The body must be immobilized by fixing its upper part and head.
If the victim has lost consciousness, then he should be placed on his back, but with a half-turn (place a cushion of clothing under the body), and his head should be tilted to the side to prevent choking on vomit.
Treat the head wound with an antiseptic and perform aseptic dressing from a sterile bandage.
Remove dentures, jewelry and glasses.
Unfasten clothing that restricts breathing and blood circulation.
With absence respiratory disorders the victim can be given to take Analgin with Diphenhydramine.
Apply cold to your head.

After the ambulance arrives and during transportation to medical institution the following activities are carried out:

Diuretics (Lasix), drugs to support cardiac activity (Sulfocamphocaine, Cordiamin) and glucose solution are administered. In case of massive bleeding, a solution of Gelatinol or Polyglucin is administered instead of a diuretic.
If there are signs of respiratory distress, oxygen is inhaled through a mask.
When motor excitation appears, Suprastin is administered.
The use of painkillers can be done with caution and only in the absence of massive bleeding and respiratory problems. Usage narcotic analgesics excluded, because they can provoke breathing disorders.

Which doctor should I contact?

If you suspect a fracture of the bones of the base of the skull, you must call an ambulance and take the patient to a medical facility. In the future, he will need treatment from a neurosurgeon and consultation with a neurologist, otolaryngologist and ophthalmologist. To clarify the diagnosis, radiography, CT and MRI are prescribed.

Diagnostics

For any traumatic brain injury, an examination is required to identify fractures of the base of the skull. Medical examination includes:

examination and interview of the victim;
determining the circumstances of the injury;
neurological examination;
examination of the pupils;
identifying the presence of deviation of the tongue from the midline and the symmetry of the grin of the teeth;
pulse examination.

After this, the following instrumental studies are carried out:

radiography of the skull (images are taken in two projections);

Treatment

Treatment of fractures of the base of the skull should be carried out in neurosurgical department with the participation of a neurologist, ophthalmologist and otolaryngologist. In the early stages, antibiotics are prescribed to prevent the development of purulent complications. wide range action, the nasopharynx and middle ear are sanitized (they instill antibacterial agents). During development purulent processes additional endolumbar administration of antibiotics is performed (into the subarachnoid space). For this, Kanamycin, Monomycin, Polymyxin or a drug selected after analysis (culture) to determine the sensitivity of the flora to a particular drug can be used. The material for such an analysis can be a sample of cerebrospinal fluid or a swab taken from the nasal mucosa.

Further treatment tactics are determined by the severity of the fracture; it can be conservative or surgical.

Conservative therapy

Conservative treatment methods can only be used for mild and moderately severe injuries, in which liquorrhea can be eliminated without surgery.

The patient is advised to adhere to strict bed rest with an elevated position of the head, preventing the release of cerebrospinal fluid. To reduce swelling, the patient is prescribed dehydration therapy. To do this, every 2-3 days a lumbar puncture is performed (removal of cerebrospinal fluid from a puncture in the lumbar region) and the same volume of oxygen is injected into the subarachnoid space (subarachnoid insufflation). In addition, diuretics (Diacarb, Lasix) are prescribed to eliminate edema.

Surgery

Indications for neuro surgery are the following cases:

the presence of compression or damage to brain structures;
the presence of a comminuted fracture;
inability to stop liquorrhea from the nose using conservative methods;
relapses of purulent complications.

The above cases can pose a direct threat to life and can only be eliminated through surgery. To perform this, craniotomy is performed. After the intervention is completed, the open area of the skull is closed with a special plate or a section of previously removed bone. After such operations, the patient requires long-term rehabilitation, the program of which is compiled individually.

Consequences

The nature of the consequences for fractures of this part of the skull depends on their severity, the presence of purulent complications and concomitant diseases. The consequences of such injuries can be direct or long-term.

Direct consequences occur at the time of injury. These include:

formation - small accumulations of blood can resolve on their own, but large ones compress the brain tissue and require surgical removal;
damage to brain tissue - depending on the location of such damage, vision, hearing may be lost, or breathing may be impaired;
purulent complications - pathogenic microorganisms lead to the development, or formation of abscesses.

Long-term consequences of such injuries develop some time after recovery. Typically this period ranges from several months to 5 years. The reason for their appearance is incomplete restoration of brain tissue or the formation of scars in the fracture area, which causes compression of blood vessels and nerves. TO long-term consequences The following complications include.

A calvarial fracture is an injury that disrupts the integrity of the braincase. The cranial vault is where bones are connected by sutures. Is directly involved in this connective tissue. Some seams are a jagged line, others are smooth. On the lateral surface of the arch there is a temporal platform, which turns into a fossa. In the front part of the arch there is a convexity, which is well known to all of us under the name “forehead”. In the back there are three convexities - the parietal tuberosities and the occiput. Between them there is a protruding point - the crown. The cerebral surface of the cranial vault has a number of irregularities that repeat the relief of the brain. It also has grooves of venous sinuses and imprints of blood vessels.

Joint injuries to the base and vault of the skull are common, and there are also differences in the causes that lead to injuries to these two areas.

Causes

There are two mechanisms of fracture occurrence.

Direct fractures. Such injuries develop where the action of a damaging force is manifested, and the bones bend into the skull. In this case, the inner plate of the skull bone breaks first.
Indirect fractures. The action of the damaging force extends beyond the site of injury, and the bone in this case bends outward.

Most often, fractures occur as a result of everyday incidents, for example, during a fight or as a result of a blow to the head with a heavy object. Fractures also occur in road accidents, falls from heights and work-related injuries.

Classification

From the pathoanatomical side, there are cracks that have one or another length, which are in contact or have several spread edges, that is, slit-like fractures. Let's look at more specific types of cranial vault fractures.

Comminuted fractures. They can be tied or free soft tissues and bone fragments. An indentation or indentation is often observed. If a fracture is accompanied by this phenomenon, the inner plate is especially severely injured. It cracks very easily and produces quite a lot of fragments. Delving deep into the skull, they tear meninges, so the brain itself is damaged. In addition, when the dura mater is ruptured, its middle artery or branches, as well as venous nodes, are often damaged. All this leads to the formation of significant hematomas, that is, accumulations of blood.
Perforated fractures. In this case, a hole is formed in the skull bone.
Closed fractures. With such injuries, the symptoms are not very pronounced, however, there is always pain at the site of injury, although it can be caused by a simple bruise. Often there is no depression in the bone or the edge of the crack protruding above a flat plane. It is difficult to determine the unevenness of the skull due to the subgaleal hematoma, which is located above the site of injury. However, a fracture can be determined using a painful strip, which is directed along the bone crack.
Open fractures. In this case, there is a through violation of the integrity of the cranial cover. Clinical picture very clear. If, after shaving your hair and treating it with iodine tincture, you push the edges of the wound apart, you will see a skull crack, indentation, and sometimes even bleeding medulla. With perforated fractures, the brain protrudes and pulsates.

Vault fractures can extend to the cranial base. In this case, we are usually talking simply about a fracture of the base of the skull. They occur as often as isolated injuries of the cranial vault. Continuation of the injury to the arch to the base often occurs in the form of a crack. This situation of transfer of injury from one part to another in this case is completely justified. The fracture that occurred in the frontal part of the vault passes to the anterior fossa of the skull. The fracture line moves to the optic opening through the orbital arch. Everything may end at this point, but the situation can develop further, even in the opposite direction through the large wing of the main bone. This is just one example of how injury to one part of the skull spreads to another area.

Symptoms

Wherever the damage is directed, it is necessary to pay attention to the symptoms that are inherent in it. First, let's highlight local manifestations.

, it is observed in the scalp;
wound in case of an open fracture;
depressions that are identified and visible upon palpation.

General signs may vary. It all depends on the nature and extent of the damage. There may be loss of consciousness for a short time or deep coma. Sometimes respiratory disorders and paralysis develop. The injured person may be conscious, however, forget the circumstances in which the injury occurred or the events preceding it. It is important to understand that the degree of impaired consciousness depends on the severity of the injury. It may happen that a person comes to his senses after a loss of consciousness that occurred immediately after the injury. However, you should be prepared for the fact that after a few hours or even days he will lose consciousness again.

Often the cranial vault is observed in those who are in drunkenness. In this case accurate diagnosis is established only after the victim sobers up. Since a fracture of the calvarium is often combined with trauma to the base of the skull, let us consider what signs are observed in this case.

Treatment

The conscious victim should be placed on a stretcher on his back, without using pillows. An aseptic bandage should be applied to the wound. If a person has lost consciousness, he must also be placed on his back and on a stretcher, but in a half-turn position. To achieve the goal, you need to place a cushion under some side of the body. The roller can be made from clothes. The victim should have his head turned so that when vomiting, the vomit does not get into the respiratory tract, but flows out. You should unfasten constricting clothing, remove glasses and dentures. Such first aid is necessary and can save a person’s life.

The patient is then taken to the neurosurgery department, where a thorough diagnosis is carried out and treatment is prescribed. If a fracture occurs cranial base, conservative or surgery. If the damage is not severe and there is no displacement, you can do without surgery, as well as if you can eliminate the loss of cerebrospinal fluid without surgery. The patient is prescribed bed rest.

In case of severe injuries, surgical treatment may be prescribed.

Prognosis and rehabilitation largely depend on how correctly first aid is provided. Of course, the nature and severity of the damage matters. It is impossible to say exactly what awaits the victim in the future, however, if you managed to save his life now, then the worst is over!