Comminuted skull fractures are formed upon impact. Fracture of the base of the skull: symptoms, survival, consequences

A fracture of the cranial vault 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 neck, temples, ethmoid and wedge-shaped parts of the head.

Consequences of injury

Fractures of the calvaria cause a tear in the dura mater. 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 head injuries. 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.

The most common damage cranial fossa located in the middle. 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 a patient is diagnosed with an injury to the temporal bone, then its tip can be torn off and ruptured. eardrum. This will lead to sharp deterioration hearing and bruising in the area of the mastoid process.

Breakage 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.

If 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 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 of the frontal bone and into the lattice partitions. If the occipital part is damaged, the caudal group of nerve endings is damaged, which makes it difficult for the whole organism to work.

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

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 artificial respiration is performed. 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 is agitated motor activity, then Suprastin or Cordiamin is intramuscularly injected.

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 relieve pain 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 by various pathologies resulting from traumatic infection of the soft brain tissues. When diagnosing a fracture without displacement of the bone, 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, a person will develop encephalopathy and uncontrolled jumps in blood pressure in the future. 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 have a lumbar puncture periodically. At the same time, 30-40 ml of cerebrospinal fluid, subarachnoid insufflation and not a large number of oxygen. 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 abscesses, 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 conservative treatment. Similar treatment will help reduce intracranial pressure and normalize brain function.

Fracture of the cranial vault is a serious injury, which is characterized by a violation of the integrity of the bones of the skull that form it upper part, i.e. vault. In the statistics of injuries, a skull fracture occupies up to 8% of all types of fractures. Such an injury is complex and can cause death of the victim as a result of compression or damage to the brain.

The vault of the skull 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 median line of the body. Front vault formed frontal bone, and behind the occipital bone. The connection of the frontal bone with the parietal forms a coronal or frontal bone suture. Compound occipital bone with the parietal forms a lambdoid suture. 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 the fracture

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

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

Most skull fractures occur either as a result of blows to the head with heavy blunt objects with a small contact surface, 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 density of the bone. Fracture of the cranial vault, photo.

Classification

To determine the tactics of managing a patient with a diagnosis of a fracture of the bones of the cranial vault, it is necessary to accurately establish the nature of the fracture.

According to the nature of the fracture, one 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 the lamellar bone. A linear fracture is one of the most successful options and has minimal risk development serious complications, however, there is still a risk of damage adjacent to the inner plate cerebral arteries, which may lead to the development of epidural hematoma of the brain;
depressed fracture. Occurs as a result of the first mechanism of injury. In this case, the inner plate is deformed and pressed into the substance of the brain. This situation can lead to rupture of the dura mater and trauma to the cortex. 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. A fracture of the cranial vault of this type is formed with the strongest blows to the cranium. When a fracture is formed, a large number of fragments of broken bones. As a rule, 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 variety is a perforated fracture. Damage occurs as a result of the impact of a small object on the bone. An example would be a gunshot fracture or a blow with 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 are almost always damaged.

Skull fracture symptoms

When a fracture of the bones of the cranial vault occurs, a number of syndromes occur that form a characteristic clinical picture. The symptoms of a fracture of the cranial vault include local - local and general - changes in all organs and systems.

TO local symptoms can be attributed to a visually detectable hematoma or rupture skin at the point of direct impact. With significant fractures, the deformation of the cranium is determined. The victim may also be bleeding.

TO cerebral symptoms includes a fairly large number of signs that allow us to judge the severity of the condition of the victim. strong headache, which occurs at the time of injury and does not go away when taking analgesics. The victim may be disturbed by 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 vital functions, the victim has uneven pathological breathing, most often of a superficial nature. Arterial pressure can be significantly reduced, the pulse becomes barely perceptible, thready. If the substance of the brain is damaged, paralysis of the motor muscles can occur. The patient's condition directly depends on the presence of hemorrhage and cerebral edema. If edema or hemorrhage occurs, intracranial pressure increases significantly, which can subsequently lead to brain dislocation and inhibition 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 fracture of the cranial vault, it is necessary to conduct a standard diagnostic complex. The examination begins with the collection of an anamnesis 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 a light gap. During the lucid interval, the condition of the victim remains stable despite injuries, however, often the luminous interval is an unfavorable prognostic sign.

The doctor necessarily examines the pupil and checks the reflexes, which helps to topical diagnostics for defeat various departments central nervous system. Without fail, the victim undergoes an x-ray of the head area in two projections, which helps to confirm the diagnosis of a fracture of the bones of the cranial vault. To clarify the localization of the fragments and draw up an accurate plan for surgical intervention, the diagnosis is supplemented computed tomography. To determine the extent of damage nervous tissue used magnetic resonance imaging and positron emission tomography of the brain.

Treatment

Medical tactics will depend on the type of fracture and the severity of the brain injury. 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 cranial vault, primary surgical treatment wound surfaces scalp. Then produce hemostasis (stop bleeding) and suturing the wound.

Things are more complicated if the fracture of the cranial vault 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, extracting the subdural hematoma and suturing the skin defect of the scalp. The victim must be prescribed concomitant antibiotic therapy to reduce the risk of developing meningitis or encephalitis.

In case of a closed fracture with a 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 lethal outcome. To prevent compression of the brain tissue by edema or hematoma, decompression of the brain is used. The patient is taken to the emergency operating room and decompressed by placing burr holes on the head. Trepanation avoids dislocation of the brain and the development of herniation medulla oblongata into the foramen magnum.

With 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 cranial vault, it can be of different diameters. The doctor bites out a section of the bone with special nippers, edematous brain tissues can enter the hole. Later, the defect is closed with a special plate when the threat to life disappears. Such an operation is called decompression trepanation according to Cushing.

Decompression trepanation according to Cushing

In addition to surgical treatment, the victim on the first day is necessarily in the intensive care unit, where all vital signs are monitored. important features until the state of health stabilizes. There is control over respiratory system, saturation, systemic hemodynamics, blood coagulation. Mandatory controlled daily diuresis and fluid and electrolyte balance, so as not to miss the development of cerebral edema. Powerful antibiotic prophylaxis is being 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 fracture of the calvarium is hospitalized 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

With untimely provision of medical care, the consequences of a fracture of the cranial vault can be very deplorable. Most formidable complication- development of cerebral edema and wedging of the medulla oblongata into the foramen magnum. This results in inhibition of the vasomotor and respiratory centers located in it, which inevitably leads to a fatal outcome.

With serious damage to the nervous tissue by fragments, the victim may develop paralysis of the skeletal muscles, which leads to deep disability. In the remote period after the injury, the patient may experience changes in character and behavior. Often patients begin to worry about epileptic seizures.

Among injuries with high mortality, a 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 base fracture is accompanied by damage to the cranial vault. What is the outcome of such an injury, statistics will best tell - lead to death in 20% of cases. The survival rate for a skull base fracture is directly related to the complexity of the injury and the age of the victim. over the age of 50 are more likely to result in death.

To cause such damage as a skull fracture can only strong impact. The bones of the head are distinguished by increased strength, and it will not be possible to damage them 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 fracture of the skull implies a crack of clear geometry. Violation of the integrity of the meninges is not excluded, according to the prognosis in comparison with other injuries is favorable;
multisplintered- are closed and open. The latter occur more often and are accompanied by polytrauma. Of particular danger is the crushing of the brain;
depressed- the presence of multiple fragments is not necessary, but a depressed skull fracture is dangerous because part of the bone tissue penetrates inside the skull. An impression fracture of the skull is often fatal;
breakdown- they account for the most a large percentage mortality. Perforated fractures of the skull are characterized by penetrating injuries. The characteristics of the inlet allow us to conclude how the injury was inflicted. Most often it is a gunshot wound.

It is not always possible to unequivocally establish the type of skull fracture, since at the same time there are various violations. So a comminuted fracture of the skull is accompanied by damage to the optic nerve, organs of vision and hearing, bone structures of any localization. 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;
medium- 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,.

An injury to the base of the skull, that is, a basilar fracture, is joined, there are frequent cases of scalping of the skull. If the cause of the damage was compression, then comminuted fractures are observed. Depression fracture of the skull is one of the varieties of depressed.

The mechanism of formation of such an injury is as follows: an object with a huge impact force and a large area of contact falls on the base of the skull. Such damage is typical for frontal sinus And temporal region, where the structures are thinner. With repeated trauma to an old wound, a terrace-like fracture occurs - the fragments are arranged in a stepped order, which is why the injury got its name.

ICD 10 injury code

By international classification diseases code of cranial injuries - S02. A skull fracture is determined by the location of the injury. So, the injury of the arch is indicated by the code S02.0, - S02.3. According to ICD 10, a fracture of the base of the skull is coded S02.1. Additional numbers after the main code indicate the nature of the fracture - open or closed.

Causes

Fractures of the bones of the skull, as a rule, occur during 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 motorcycle and cycling.

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

Fracture of the base of the skull is formed when exposed to a blunt object with great strength. A falling beam or log causes a fracture of the skull. With such an injury, death can occur immediately after the impact. If the victim received a slight blow, then a crack will occur. Due to damage to the skull, dizziness and disorientation 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, an eyebrow dissection occurs or. The nasal passage is destroyed, the orbits are injured, bone fragments can disrupt the functions of important organs. How hit harder, topics more likely comminuted fracture.

The most dangerous is the injury received during the compression of the cranium. This occurs in car accidents, when the victim is sandwiched between vehicles. During the fighting, shrapnel and gunshot wounds occur. If the meninges are damaged, then the probability of death is high. In a bullet wound, brain fluid leaks out through the hole and the brain tissue dies.

Symptoms

Signs of a skull fracture are the loss of consciousness or disorientation of the victim. If a person is conscious, he will complain about unbearable pain. Vision and hearing may be impaired, which is associated with damage to the olfactory or optic nerve. Due to cerebral edema, breathing is disturbed, pressure on the eyes causes multiple hemorrhages. If the blood vessels burst, then the whites of the eyes turn completely red. There is also a symptom of glasses - hematomas around the eyes.

Simultaneously observed a sharp decline hearing, bleeding from the ears. Symptoms of a skull fracture include paresis of the facial muscles, 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 can be called discharge from the nose of an unclear nature. It could be cerebrospinal fluid. The work of the vestibular apparatus is disturbed, consciousness is confused. TO typical manifestations fractures of the base of the skull include a different diameter of the pupils, loss of taste sensations, impaired cardiac activity, spontaneous urination.

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

First aid

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

Emergency first aid involves the removal of pressure clothing, jewelry, watches. If the victim is conscious and breathes evenly, then it is allowed to give analgin to reduce pain syndrome. With open wounds, they are carried out antiseptic treatment avoiding sudden or violent movements.

In case of a skull fracture with severe blood loss, painkillers are not given. Because of them, bleeding can increase. At internal hemorrhages and visible hematomas, it is allowed to apply dry cold. The rest of the treatment should be done in the clinic.

In case of 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 lay the patient on a hard surface and immobilize the head. Try to minimize shaking and displacement. Until complete immobilization, the head of the victim is held by hands.

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

Diagnostics

A traumatologist makes a diagnosis on the basis of x-rays and a survey of the victim, if he is conscious. The examination is carried out on an emergency basis, since with a skull fracture there are instant complications that can lead to death. X-ray images show the location and nature of the fracture. But X-rays are 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 by bone fragments;
CT - more informative method than radiography, shows the state of the bone structures.

If there is a hemorrhage, then edema and large hematomas appear. To assess the contents of secretions from the nose or other tissues of the head, a fluid is taken or a swab is taken. An experienced traumatologist is able to diagnose a skull base fracture even without instrumental examination. But it may be required differential diagnosis to determine the nature of head injuries. The tactics of treatment also depend on this.

Treatment

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

In open trauma, the focus is on fighting infections. The wound is sanitized, the patient is given antibiotics. When closed fracture get by conservative treatment: the patient is provided with rest, laid with elevation to avoid the outflow of cerebral fluid, a cleol bandage is applied. Usually, a tile-like adhesive bandage is applied for a fracture of the movable joints, but in case of serious injuries of the skull, it will replace the traditional circular bandage.

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

Before full recovery the patient is given rest. The prognosis is favorable if the injury was without displacement and infection was avoided. At the discretion of the attending physician, they are prescribed to improve the fusion of bone tissues. They are especially needed in the case of taking diuretics.

endonasal electrophoresis- activates blood circulation, prevents hypothalamic syndrome eliminates bruising in the affected area;
central electroanalgesia– stops stress reactions, has a sedative effect;
electroplated collar- soothes, relieves spasms, has a local analgesic effect.

Development of motor skills

In case of paralysis or decrease in the accuracy of movements, exercise therapy and treatment by a kinesiotherapist are prescribed. Benefit will bring massage, hardware impact on nerve endings and muscle fibers, balneotherapy. To restore motor activity, special simulators are used, classes on which are held in rehabilitation centers.

Acupuncture prescribed by a doctor will relieve tremors, muscle weakness, blood stasis in the limbs. The methods of alternative medicine will help to strengthen 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 a lot like stroke therapy. A set of measures is selected by the attending physician and specialists in narrow areas: a neurologist, a neurosurgeon, a rehabilitation specialist.

Help from a psychologist

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

Changes in higher nervous activity lead to the fact that a person becomes "alien" to his environment. At the stage of rehabilitation with a psychologist, the victim manages to accept his changed personality and return to his former life. Psychological practices will be able to help in this: art therapy, group treatment, etc.

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

Complications and consequences

Negative consequences after a fracture of the base of the skull appear when open injuries with an 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 former life. The victim may fall into a prolonged coma, but even after the return of consciousness, parts of the brain will not function fully.

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

Infectious diseases often lead to encephalitis and meningitis. These consequences of a skull base fracture are the most difficult to treat. In case of purulent complications, it is necessary to carry out repeated trepanation. The next intervention threatens to worsen the functions of the brain, even with successful treatment.

Sometimes complications occur after 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 a 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.

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

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

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

Article author:| orthopedic doctor Education: Diploma in the specialty "Medicine" received in 2001 in medical academy them. I. M. Sechenov. In 2003, she completed postgraduate studies in the specialty "Traumatology and Orthopedics" in the City clinical hospital No. 29 im. N.E. Bauman.

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

These fractures can be caused by direct blows to the lower jaw or on the head, traffic accidents, playing sports (especially extreme sports), falling from a height, industrial emergencies, etc. In this article, we will introduce you to the types, symptoms, methods of first aid, treatment methods and the 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 time and correctly, increasing his chances of 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 breaking bones, but also high risk violation of the integrity of adjacent organs. The proximity of such vital organs as the head and spinal cord, determines the inclusion of such fractures in the emergency response list, since their receipt almost always poses a threat to life. Fracture of the base of the skull may be self injury or combined with damage to the bones of the arch (in about 50-60% of cases).

Classification

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

linear - a 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;
comminuted - when broken, several fragments are formed that can injure the membranes and tissues of the brain (crush of the brain, subdural and intracerebral hematomas);
depressed - the fragment is pressed (immersed) into the cranial cavity and causes the same damage as a comminuted fracture.

According to the place of localization, 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 region of the middle cranial fossa. Depending on the nature of the fault line, they can be transverse, longitudinal or oblique.

Damage mechanisms

Fractures of the bones of the base of the skull in almost all cases are accompanied by a rupture of the dura mater. In this case, the communication of the oral cavity, nose, paranasal sinuses nose, middle ear and orbit with air external environment. It can lead to the ingress of microbial agents and infection of brain tissues, the appearance of post-traumatic pneumocephalus and the expiration cerebrospinal fluid from the ears and nose (ear and nasal liquorrhea).

In case of 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 can flow 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 nerve. Such injuries may be accompanied by concomitant injuries of the diencephalic regions 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 short-term fainting or prolonged coma. When forming intracranial hematoma there may be a short period of enlightenment before loss of consciousness, which should not be taken as a sign of minor trauma.

Common symptoms of a skull base fracture include:

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

Fractures of the pyramid of the temporal bone

With such injuries, fractures can be longitudinal, transverse, diagonal, and with separation of the apex. A transverse fracture provokes paralysis of the facial nerve, disturbances in the functioning of the vestibular apparatus, complete loss of hearing and taste. With longitudinal fractures, the canal of the facial nerve, the inner and middle ear are damaged. At the same time, partial hearing loss develops, tympanic membrane rupture, bleeding and leakage of cerebrospinal fluid from the ear, hemorrhage in the temporal muscle and behind the ear. When you try to turn your head, the bleeding becomes more intense. Therefore, such victims are strictly forbidden to turn their heads.

Fractures of the anterior cranial fossa

Such injuries are accompanied by epistaxis and nasal liquorrhea. After 2-3 days, a "glass symptom" appears. With fractures of the cells of the ethmoid bone, subcutaneous emphysema develops and blisters form on the skin.

Fractures of the middle cranial fossa

Such injuries are accompanied by the development of unilateral ear liquorrhea, which develops as a result of tympanic membrane rupture, and unilateral bleeding from the ear. In the victim, hearing is sharply reduced or disappears completely, bruising appears in the region of the temporal muscle and behind the ear, the functions of the facial nerve and taste sensations are disturbed.

Fractures of the posterior cranial fossa

With such fractures, bruises appear behind one or both ears of the victim, there are violations of the functions of the facial, abducent and auditory nerve. In victims, the functioning of vital organs is disrupted. With ruptures or infringement of the caudal nerves, paralysis of the tongue, larynx and palate develops.

First aid

The outcome of such injuries largely depends on the correctness of first aid. In case of any suspicion of such damage, an ambulance should be called immediately. After that, the following actions are required:

Lay the victim on their 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 laid on his back, but with a half turn (put a roller of clothes under the body), and tilt his head to the side to prevent choking with vomit.
Treat the wound on the head with an antiseptic and perform aseptic bandage 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 the head.

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

Diuretics (Lasix), drugs to maintain cardiac activity (Sulfocampocaine, Cordiamin) and a glucose solution are introduced. In case of massive bleeding, instead of a diuretic, a solution of Gelatinol or Polyglukin is administered.
With signs of respiratory disorders, oxygen is inhaled through a mask.
With the appearance of motor excitation, Suprastin is introduced.
The use of painkillers can be performed with caution and only in the absence of massive bleeding and respiratory disorders. Usage narcotic analgesics excluded, since they can provoke respiratory disorders.

Which doctor to 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 consultations with a neurologist, an otolaryngologist and an ophthalmologist. To clarify the diagnosis, X-ray, CT and MRI are prescribed.

Diagnostics

With any traumatic brain injury, an examination is mandatory to identify fractures of the base of the skull. The medical examination includes:

examination and questioning of the victim;
clarification of the circumstances of the injury;
neurological examination;
pupil examination;
detection of the presence of a deviation of the tongue from the midline and the symmetry of the grin of the teeth;
pulse study.

After that, the following instrumental studies are carried out:

x-ray of the skull (images are performed in two projections);

Treatment

Treatment of skull base fractures should be neurosurgical department with the participation of a neurologist, an oculist and an otolaryngologist. In the early stages, antibiotics are prescribed to prevent the development of purulent complications. a wide range actions, sanitation of the nasopharynx and middle ear is performed (they are instilled antibacterial agents). With the development purulent processes additional endolumbar administration of antibiotics (into the subarachnoid space) is performed. For this, Kanamycin, Monomycin, Polymyxin or a drug selected after analysis (seeding) to determine the sensitivity of the flora to a particular agent can be used. The material for such an analysis can be a sample of cerebrospinal fluid or a smear made from the nasal mucosa.

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

Conservative therapy

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

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

Surgery

Indications for neuro surgical operation are the following cases:

the presence of compression or damage to brain structures;
the presence of a multi-comminuted fracture;
the impossibility of stopping liquorrhea from the nose using conservative methods;
relapses of purulent complications.

The above cases can carry a direct threat to life and are eliminated only with the help of a surgical operation. For its implementation, a trepanation of the skull is performed. After the intervention is completed, the open area of the skull is closed with a special plate or a section of a previously removed bone. After such operations, the patient needs a long-term rehabilitation, the program of which is compiled individually.

Consequences

The nature of the consequences of 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:

education - small accumulations of blood are able to dissolve on their own, and large ones compress the brain tissue and need to be surgically removed;
brain tissue damage - depending on the location of such damage, vision, hearing may be lost, or respiratory failure occurs;
purulent complications - pathogenic microorganisms lead to the development, or the formation of abscesses.

Long-term effects of such injuries develop some time after recovery. Typically, this period ranges from several months to 5 years. The reason for their appearance is the 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 include the following complications.

Fracture of the cranial vault is an injury in which the integrity of the brain box is violated. The cranial vault is the joints of the bones by sutures. This is directly involved connective tissue. Some seams are a jagged line, others are even. On the lateral surface of the arch there is a temporal platform, which passes into the fossa. In front of the arch has a bulge, which is well known to all of us under the name "forehead". In the back there are three bulges - the parietal tubercles and the back of the head. Between them 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 the venous sinuses and imprints of blood vessels.

Often there are joint injuries of the base and the calvaria, in addition, there are differences in the causes that lead to injuries of these two areas.

Causes

There are two mechanisms of fracture occurrence.

Direct fractures. Such injuries develop where the action of the damaging force is manifested, with the bones bending inside 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 injury site, and the bone in this case bends outward.

Most often, fractures occur as a result of domestic excesses, for example, during a fight or as a result of a blow to the head with a heavy object. Also, fractures occur in road accidents, falls from a height and industrial injuries.

Classification

On the pathoanatomical side, cracks are distinguished, having one or another length, which are in contact or have several extended edges, that is, slit-like fractures. Let's consider more specific types of fractures of the cranial vault.

Comminuted fractures. They can be with bound or free soft tissues and bone fragments. Often there is an indentation or depression. If the fracture is accompanied by such a phenomenon, the inner plate is especially severely injured. It cracks very easily and gives a lot of splinters. Deepening inside the skull, they tear meninges so the brain 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 the 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 subaponeurotic hematoma, which is located above the injury site. However, a fracture can be determined by using a painful strip that is guided 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 the hair and treating with iodine tincture, the edges of the wound are moved apart, it will turn out to see a cranial fissure, indentation, and sometimes expiration medulla. With perforated fractures, the brain protrudes and pulsation is determined.

Fractures of the vault can be extended to the cranial base. In this case, it is usually just a fracture of the base of the skull. They are as common as isolated calvarial injuries. The continuation of the injury of the arch to the base often proceeds in the form of a crack. Such a situation of the transition of the injury of one part to another in this case is quite justified. The fracture that occurred in the frontal part of the arch passes to the anterior fossa of the skull. The break line moves to the optic opening through the arch of the orbit. At this point, everything can end, 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 an injury to one part of the skull moves to another area.

Symptoms

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

, it is observed in the scalp;
wound in case of an open fracture;
impressions that are detected and visible on palpation.

General signs may be different. 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 under 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 came to his senses after losing 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 again lose consciousness.

Often the vault of the skull is observed in those who are in drunkenness. In this case accurate diagnosis is established only after the victim has sobered up. Since a fracture of the cranial vault is often combined with an injury to the base of the skull, let's consider what signs are observed in this case.

Treatment

The victim, who is conscious, 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 should also be placed on his back and on a stretcher, but in a half-turn position. To achieve the goal, you need to put a roller under one side of the body. The roller can be built 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.

Then the patient is taken to the Department of Neurosurgery, 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, surgery can be dispensed with, as well as if it is possible to eliminate the loss of cerebrospinal fluid without surgery. The patient is placed on 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 injury matters. It is impossible to say exactly what awaits the victim in the future, however, if it was possible to save his life now, then the worst is over!