Linear fracture of the cranial vault. Skull fracture, consequences, signs, assistance

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

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

Most common head injury

The following types of disorders occur with a head injury:

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

There are no specific symptoms that can distinguish a head contusion from a fracture. It is impossible to diagnose the nature of the injury on its own. Even if you suspect minor damage head, it is necessary to go to the hospital. There are some traumatic brain injuries that are asymptomatic at first, and then lead to irreversible consequences, up to lethal outcome.

Types of skull fractures

All skull fractures are divided into:

base fracture;
vault fracture.

In the second option, the bone, brain and its membranes are damaged. A skull base fracture is typically characterized by cracks that extend into the nose, eyes, and may involve the ear canal.

All damages also differ in nature:

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

Skull fracture symptoms

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

vomit;
bright bruising under the eyes;
pupils do not respond to stimuli or have a different size;
excessive movements or complete paralysis;
blurred look;
Very severe pain in my head.

There are some signs that are typical for a certain kind damage is:

Fracture of the base of the skull - suffers, as a rule, visual system and smell. The brain is connected to the nasal and eye canals, after which they penetrate there various infections that cause most dangerous diseases. If this type of fracture is also splintered, then there is a risk of damage to the arteries, which leads to hemorrhages and hematomas.
In case of violation of the back cranial fossa bruises are found in the ear area. Facial and ear nerves. Possible paralysis of the tongue or larynx. In severe cases, internal organs are damaged.
Fracture of the middle cranial fossa frequent symptoms are ear bleeds. There is a rupture of the eardrum. There may be bruising around the temple or ear. This injury is one of the most common types of skull fractures.
Symptoms of damage to the anterior fossa are nosebleeds or discharge of cerebrospinal fluid from the nose. In addition, such an injury is characterized by the appearance of bruises in the eye area.

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

Diagnostics

With a skull injury, timely diagnosis can save a life. The patient, who is conscious, initially undergoes a visual examination. The doctor asks about the circumstances of the injury, writes down the symptoms and carefully examines the injured area. In addition, the specialist neurological examination, checks the reaction of the pupils, various reflexes, measures the pressure. Then, to confirm the diagnosis, instrumental examination with the help of x-rays.

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

What to do with a fracture?

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

conservative;
surgical.

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

shake;
injury;
fracture of the base of the skull in a closed form.

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

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

Forecast

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

The situation is worse with severe fractures of fragmentation and depressed type. Also, an open fracture of the base of the skull can be attributed to complex conditions. The survival rate for such injuries, as a rule, is 50/50. Some patients do not even live to see operating table. Others die on the first day of surgery. Usually, after this time, the chances of life increase many times over. Such patients can either fully rehabilitate or remain disabled. It all depends on the severity of the injury. In any case, the rehabilitation process is long and painful.

Rehabilitation

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

long rest;
walks in the open air;
diet food;
taking mild sedatives;
drugs to improve cerebral circulation;
implementation of doctor's recommendations.

Often these patients are treated at home. TO minor injuries heads are:

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

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

open fracture base of the skull;
depressed;
fragmentation.

The way of life of such patients changes greatly. Not everyone will be able to return to habitual behavior. These patients stay in the hospital for a long time. Then translated to home treatment. Often, patients with such a diagnosis are recommended to visit a sanatorium. Rehabilitation can take years.

Fracture of the base of the skull in children

What to consider if your child is diagnosed with a skull fracture? Consequences. The baby's lifestyle can change significantly, so parents try to ask the doctor about the severity of such damage in as much detail as possible. Head injuries are common in children despite public opinion that the skull of a child is stronger than that of an adult. Doctors unanimously say that this is not so. Children themselves are very mobile and inattentive. Sometimes it's hard to foresee trouble in time. Linear fracture, fragmentation, depressed, fracture of the base of the skull - in children, such injuries account for 70 percent of all head injuries. Symptoms, diagnosis, and treatment do not differ from adult injuries. In such cases, special children's drugs may be recommended to improve cerebral circulation.

What to do before the arrival of doctors?

For any traumatic brain injury, contact medical institution Necessarily. If the victim is conscious, before the ambulance arrives, he is placed on his back. Cold can be applied to the injury site. IN difficult situations when the patient does not respond to external stimuli, it must be carefully laid on its side and supported with soft improvised objects. Also, with something soft, such as clothes or pillows, it is necessary to fix the head so that the victim does not choke on his own vomit. Plus, it will prevent the tongue from sinking. You need to call an ambulance as soon as possible, saying that the person is in serious condition. It is not recommended to do anything else until the arrival of the doctors. It is strictly forbidden to feel the head of the victim on your own.

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

Consequences of injury

Fractures of the calvaria cause rupture of the dura meninges. During this process, a hole is formed through which the cerebrospinal fluid (liquorrhea) flows out. A similar hole can be located in the region of 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 that damage brain tissue may occur.

Signs and symptoms of a skull fracture:

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

All skull fractures are classified as open injuries heads. In the event that the patient has an abundant flow of blood and cerebral fluid, 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 to the cranial fossa, located in the middle, occurs. Such cases account for 50-70% of the total number of skull base fractures. In this case, the type of bone fracture can be longitudinal, oblique or transverse. If the patient is diagnosed with an injury temporal bone, then in this case, its top can be detached and the eardrum. This will lead to a sharp deterioration in hearing and the appearance of bruising in the mastoid region.

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

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

Periodically, damage to the anterior fossa leads to the formation of emphysema. The causes of its occurrence are the ingress of air from the nose into the lobes frontal bone and in lattice partitions. If the occipital part is damaged, the caudal group is affected nerve endings which hinders the performance of the entire body.

First aid

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

Then, when the victim is unconscious, he should be laid on his side. In this case, the injured part of the head should be on top, and a roller of folded clothes should be placed under the back. This will prevent the person from rolling back. IN without fail the head should be turned to the side, this will help the patient not to choke on his own vomit. Tight clothing should be loosened, and existing prosthetic teeth, eyes, and glasses removed.

If a failure occurs respiratory process, then done artificial respiration. It is best to do it through a special mask. Then an injection is made with a drug that stimulates the work of the heart, but pain medication should be abandoned, as this can disrupt the respiratory process.

If possible, intravenous glucose solution or Lasix should be administered. If the patient has an excitation of motor activity, then Suprastin or Cordiamin is injected intramuscularly.

In the event that the arrival of the ambulance is delayed, an ice pack is required to be applied to the patient's head. This will help remove pain spasms and stop bleeding. If he is observed 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 are different, and their severity will depend on the nature of the damage. Moreover, it can be influenced various pathologies that appeared as a result of traumatic infection of the soft brain tissues. When diagnosing a fracture without displacement of the bone, which does not cause purulent formations, the probability is very high favorable outcome affairs.

If complications develop infectious nature(meningitis, encephalitis, etc.), then, most likely, a person will develop encephalopathy and uncontrolled jumps in the future blood pressure. Especially often this can happen in children (infant or infant), because their body has not developed strong immunity. 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 care, then he may die. It is especially important to stop the bleeding 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 a skull fracture depends entirely on the severity of the fracture and the quality of the treatment. Therefore, in order to reduce the likelihood of side ailments you should seek help from qualified professionals.

The treatment process and its varieties

Fracture treatment can be different methods. Among them are distinguished conservative method And surgical intervention. Besides, great attention should be given further preventive measures. In the process of treatment, the patient should be examined by a neuropathologist, 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 be in bed, and his head should lie on a hill. This position reduces the risk of leakage of spinal cord fluid.

In addition, he should periodically lumbar puncture. In this case, 30-40 ml of CSF, subarachnoid insufflation and a small amount of oxygen should be poured. The frequency of this procedure is 1 time in every 2 days. Diuretics are prescribed. Diacarb helps especially well, since it contains substances that reduce the production of cerebral fluid.

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

If abscesses have developed, then the intake of antibacterial drugs is combined with the endolumbar administration of antibiotics. Among these antibiotics, Levomycitin, 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, the arch of the base or the temporal parts. The operation is especially important when the brain is compressed due to the resulting pneumocephalus.

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

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

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

All fractures of the bones of the skull are divided into fractures of the cranial vault and the base of the skull.
In case of a fracture of the cranial vault, the integrity of the brain box occurs, and in case of a fracture of the base of the skull, the bones that enter the base are damaged brain department skulls (temporal, sphenoid, occipital or ethmoid).

Signs of fractures of the bones of the cranial vault

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

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

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

To determine the complexity of the injury, doctors try to assess the condition of the victim. He may be fully conscious, but completely unaware of how the injury was received and what events preceded it. Experts classify this condition as retrograde amnesia. Sometimes the patient develops stupor or coma. It should be noted that the degree of impaired consciousness is directly related to the severity of the skull injury. With a fracture of this kind, the victim has bradycardia.

Quite often, a fracture of the bones of the cranial vault occurs in people who are in a state of alcohol intoxication. For staging accurate diagnosis often you have to wait for them to sober up and only after that conduct an examination by a neurosurgeon or neuropathologist.

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

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

The manifestations of such injuries largely depend on the location of the damage. So most often doctors encounter fractures of the middle cranial fossa. They make themselves felt by bleeding from the ear, as well as the expiration of cerebrospinal fluid through the ear due to the fact that there was a perforation of the eardrum. The victim's hearing is reduced, bruising occurs in the region of the temporal muscle, as well as the mastoid process.

With a transverse fracture, hearing is completely lost, and the vestibular function and the ability to taste the front of the tongue disappears due to injury to the drum string.

With a fracture of the anterior cranial fossa, the patient has an outflow of blood and cerebrospinal fluid through the nose. In addition, pronounced bruising occurs in the region of the lower and upper eyelids, which is classified by experts as a symptom of "glasses".

If there is a fracture of the posterior cranial fossa, the patient has unilateral or bilateral bruising behind the ears. There is also a simultaneous lesion of the abducens, auditory and facial nerves. In addition, rupture of the caudal nerves may occur and bulbar symptoms: paralysis or paresis of the muscles of the palate, tongue, and larynx. Potential disruption of life important organs.

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

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

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

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

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

In some cases, trauma to the base of the skull leads to curvature of the spine ( varying degrees and different locations).

Brain damage can lead to various functions body (motor, visual, auditory, olfactory, respiratory failure, etc.), may also be disturbed mental functions. Sometimes partial or complete paralysis of the body develops.

Folk remedies

Means to help cope with the consequences of skull fractures traditional medicine. So most of the patients who have suffered such an injury are faced with the problem of headaches. To correct them, doctors often advise the use of drugs on plant-based.

So a good effect is given by an evasive peony plant.

Infusion of peony evading bath. Handful of crushed petals this plant brew a liter of boiling water. Infuse such a remedy for fifteen to thirty minutes, then pour it into the prepared bath. Take a peony bath for fifteen minutes, then go to bed.

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

A decoction of rose hips. Brew a tablespoon of the raw material obtained with four hundred milliliters of boiling water and boil over a fire of minimum power for ten minutes. Pour this broth into a thermos and leave for a day. Take the finished strained medicine one hundred milliliters twice a day. Rosehip drink can be sweetened with honey.

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

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

Fracture of the cranial vault is linear and depressed. Linear fractures occur on impact with large area contact (for example, when falling from a height onto a flat surface). If the area of the shock surface is small, then a depressed fracture occurs when the bone fragment is, as it were, immersed in the cranial cavity. In this case, the shape of the fracture, as a rule, corresponds to the shape of the instrument of injury. In children of the first year of life, peculiar fractures of the cranial vault are sometimes noted. So, in babies with incompletely ossified sutures, there may be linear fractures due to the divergence of the sutures, the so-called diastatic fractures. Depressed fractures in infants are also distinguished by their originality - these are the so-called “ping-pong ball” fractures, depression of the bone without violating its integrity, due to bending. Such fractures do not require surgical treatment, excluding localizations in which it leads to cosmetic defects.

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

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

It must be remembered that it is not always with a blow to the head that there are precisely craniocerebral injuries, and not always craniocereberal injuries are the result of a blow to the head. "Classics of the genre" can be called cases of fracture cervical spine of careless divers who jumped into the water in an unfamiliar place and hit their heads. On the other hand, a seemingly innocent joke with a chair pulled out often ends with a concussion, or even a bruise of the brain - when falling on the coccyx, the blow is transmitted throughout spinal column. There are concussions in motorists during emergency braking, in a collision - due to a sharp displacement "by inertia" of the brain inside the skull.

Features of first aid in case of a closed skull injury.

It is necessary to provide first aid for head injuries with particular care: avoid unnecessary movements and pressure, use a sterile bandage and antiseptics so as not to infect the tissues surrounding the brain. An infection that enters the wound can penetrate the skull and infect the brain and its membranes. As a result, such serious illnesses like encephalitis or meningitis. First aid procedure for head injury If the victim is unconscious, then it is necessary to check the breathing / pulse and, if there are none, to do artificial respiration and cardiac massage . If there is breathing / pulse, then it is necessary to lay the person on his side (to avoid blockage of the airways with the tongue and vomit) and call an ambulance. If there is consciousness, then simply lay the victim in a semi-lying position so that he does not move until the ambulance arrives. A person with a head injury should not be sat down, and even more so trying to raise him to his feet - this can drastically worsen his condition. If there is no obvious damage to the bones of the skull, cold should be applied to the site of impact (moistened cold water cloth or ice in a rag). This will reduce pain, stop tissue swelling, which leads to an increase in intracranial pressure.

If there is a bleeding wound on the head, it is necessary to lubricate the skin around the wound with iodine or brilliant green (to prevent infection). Then put a gauze pad on the wound and bandage head. But this should be done very carefully, especially if there is a suspicion of a skull fracture. It is not necessary to give the victim a lot of liquid, if he is thirsty, give a little sweet tea. If pieces of bone, metal or other foreign bodies, touching or removing them is strictly prohibited. This is fraught with serious consequences, as profuse bleeding and tissue damage can begin. In such cases, a bandage using a roller rolled up like a donut is recommended. To do this, cotton wool is rolled out with a “sausage”, wrapped with gauze or a bandage and laid around a protruding object. The wound is covered with a sterile napkin (in two or three layers) and bandaged. It is also possible to transport the victim only in the supine position.

Open injuries of the skull.

Open injuries of the skull and brain can occur under the action of non-firearms /secondary/ shells and gunshot wounds. With non-gunshot wounds, lacerated wounds of various sizes and shapes are most often observed with damage to only soft tissues or accompanied by damage to the bone, meninges and brain. Cut, stab and scalped wounds are much less common. Gunshot wounds of the skull and brain can be of a different nature: shrapnel and bullet / ball, arrow-shaped and other injuring projectiles /, blind, tangential, through and ricocheting.

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

Skull injuries are divided into:

Soft tissue injuries / without bone damage /,

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

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

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

Along with loss of consciousness in the wounded, vomiting, psychomotor agitation, and increasing bradycardia are possible.

First aid for injuries of the skull and brain is reduced to the imposition of an aseptic dressing on the wound, the simplest immobilization and the fastest evacuation to a medical facility.

The imposition of an aseptic dressing in case of open penetrating injuries of the skull with bulging of the brain has some peculiarities. The wound is closed with a sterile napkin, a cotton-gauze roller is applied around it in the form of a “donut” in order to prevent compression of the brain substance protruding into the wound by the bandage. After that, the napkins and the roller are strengthened by applying one of the accepted standard dressings / “cap”, “bridle” /. Immobilization is the simplest / deepening on a stretcher /. Tires are rarely fitted. The victim's head is turned to the side.

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

IN overall structure of traumatism, skull fracture is 20-30%, and among the causes of death and disability resulting from trauma - 40-60%, ranking first.

Skull fracture - violation of integrity bone tissue, while distinguishing between penetrating, with damage to the dura mater, and non-penetrating, without violating it.

Skull fracture can be open (with damage to the skin and underlying tissues) and closed (without damage to the integrity skin). Fracture of the skull by location is divided into damage to the vault, base of the skull.

Skull fracture is the leading cause of death and disability

Fractures of the calvaria

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

The consequences of this are the formation of a hematoma located between the solid and arachnoid shells brain.

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

Symptoms may be present in a depressed fracture clinic focal lesion, epileptic seizures. Depressed fractures not less than the thickness of the bone are subject to surgical treatment as soon as possible, except for depression in the area frontal sinus.

Fractures of the base of the skull

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

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

Bruising under the eyes is typical of a skull fracture

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

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

Diagnostics

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

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

Features in children

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

hallmark fractures of the cranial vault, received by a child, is their "concavity", which is explained by the increased elasticity of the bone, which allows it to easily bend without breaking.

With injuries accompanied by a blow to the head on a hard surface, the sutures diverge, multiple linear fractures of the cranial vault appear - cracks.

In a child, less often than in an adult, fractures of the base of the skull, extensive hemorrhages between the arachnoid and pia mater, and intracranial accumulations of blood occur.

Because of age features child, skull fractures in childhood, especially early childhood, are easier. But then they can form dangerous consequences such as hydrocephalus, epilepsy.

At baby with a fracture of the bones of the skull, loss of consciousness most often does not develop. General stun is replaced by increased motor activity. fluctuations muscle tone, reflexes appear dimly. On the pathology of movement, a conclusion is made on the reduced function of the damaged limbs. The child of the eldest age group the clinic is characterized by unstable cerebral manifestations and autonomic disorders. Loss of consciousness, nausea, severe vomiting, dizziness, anxiety. These phenomena are quickly replaced by apathy, lethargy, tearfulness.

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

Treatment at different stages

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

First aid principles:

In case of a skull fracture, first aid should be immediately provided at the scene.
If the victim is unconscious, then when rendering assistance, he should not be disturbed, raised, so as not to aggravate the severity of the condition.
Immobilization - to limit the mobility of the head, to create shock absorption, to prevent shaking and shocks, the head of the victim is placed on a cotton-gauze circle or an impromptu object with the back of the head in the hole to limit the mobility of the head.
Use of Kramer splints - one of the splints is bent so that it captures the forehead, follows the contours of the head from front to back and the curve of the neck up to thoracic spine; the other is curved in the shape of the shoulder girdle and head over the first splint. When they are applied, the head tilts back a little, fixed with bandages.
Transport the victim on a stretcher, in a supine position on his back without shaking with a fixed head.
To prevent blood, cerebrospinal fluid or vomit from entering the Airways Tilt your head back and turn to the side.
Simultaneously with the provision of first aid, urgent hospitalization in a specialized neurosurgical department.

Doctor's tactics open injuries skull consists in the primary phased careful treatment of the skin, bone, meninges, brain layers of wounds according to classical principles preferably no later than 12 hours after the injury occurred.

When performing surgical treatment of a wound in a child, it is required to recreate the integrity of the dura mater with the help of fascia plastics, because the achievement of sealing the cranial cavity solely due to the skin most often does not prevent the outflow of cerebrospinal fluid.

In some cases, a skull fracture requires surgical intervention

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

Most often, after the successful completion of the primary surgical treatment wounds, with the removal of fragments of bone tissue, trepanation of the skull, decide the issue of primary plasty of the skull.

Contraindications for surgery:

extensive brain defects;
significant cerebral edema;
condition after removal of large hematomas, since an increase in edema is not excluded;
the presence of signs of inflammation of the wound.

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