http://www.theprofesional.com/article/ OCT-DEC-2010/PROF-1551.pdf http://www.ijntonline.com/June08/abstr acts/abs8.

PDF INTRODUCTION Head injury is the leading cause of mortality and morbidity not only in the developed countries but also is developing countries. The incidence is increasing day by day therefore it remains a universal health and socioeconomic problem. A skull fracture is considered depressed, when any portion of the outer table of the fracture line lies below the nomwel anatomical position of the inner table Depressed skull fratures typically occur when objects with a large amount of kinetic energy. (eg. Baseball bat, hammer, rock) make contact with the skull over a fairly small area. In radiological evaluation of depressed skull fracture, x-rays (AP & lateral views) are the mandatory standard investigation for these patients where CT is not available, though the advent of CT has revolutionized the diagnosis. Skull fracture is the term used to describe a break in one or more of the eight bones which form the cranial portion as a of the skull usually occurring result

the membranes, blood vessels, and brain, even in the absence of a fracture. While an uncomplicated skull fracture can occur without associated physical in itself or neurological damage and is

usually not clinically significant, a fracture in healthy bone indicates that a substantial amount of force has been applied and increases the possibility of associated injury. Any significant blow to

the head results in a concussion, with or without loss of consciousness. A fracture which occurs in conjunction with an through overlying laceration which the meninges or the paranasal tears runs the epidermis and

sinuses and

the middle ear structures, resulting in the outside environment being in contact with the cranial cavity is termed a compound fracture. Compound fractures may either be clean or contaminated. There are four major types of skull fractures; linear fractures which are the most common and usually require no intervention for the fracture itself, depressed fractures which are usually comminuted with broken portions of bone displaced inward may require surgical intervention if there is underlying tissue damage, diastatic fractures in which the sutures of the skull widen usually affects children under three, and basilar fractures which occur in the bones at the base of the skull.

of blunt force trauma. If the force of the impact is excessive the bone may fracture at or near the site of the impact and may cause damage to the underlying physical structures contained within the skull such as

(directly or indirectly into the brain) impact injuries due to birth trauma Rebound effect to the brain (Injury) Causing diffuse axonal injury or Shearing Injuries (AXON- brings information from its cell body to other neurons) = (Neurons transmit impulses) Increased intracranial pressure which is the leading cause of death from the head trauma.

Open Head Injury The types of fractures associated with an open head injury are linear, depressed, open, and comminuted. Linear Fracture is a simple, clean break in which the impacted area of bone bends inward and the area around it bends outward Linear fractures account for about 80% of all skull fractures. Depressed Fracture, the bone is pressed inward into the brain tissue to at least the thickness of the skull. Open Fracture, the scalp is lacerated, creating a direct opening to brain tissue. Comminuted Fracture involves fragmentation of the bone with depression of bone into the brain tissue.

TYPES of FORCE : 1. Acceleration injury Caused by an external force contacting the head, suddenly placing the head in motion. 1. Deceleration Occurs when the moving head is suddenly stopped or hits a stationary object. Pathophysiology: Mechanical force

LABORATORY TESTS : There is no laboratory test to diagnose primary brain injury, however ABG (arterial blood gases) and CBC with the determination of serum glucose and electrolyte levels and osmolarity indicate the measure to prevent secondary brain insult. These test are performed to monitor hemodynamic status or to identify electrolyte imbalance or the presence of infection. Severe electrolyte imbalances can also contribute to secondary injury as well as increase the risk of seizures. INTERVENTIONS: Nonsurgical: 1. Position the client to avoid extreme flexion or extension of the neck and to maintain the head in the midline, neural position. 2. Prophylactic hyperventilation during the first 20 hours

after injury is usually avoided because it may produce ischemia by causing cerebral vasoconstriction and ICP. Medical 1. Drugs: Osmotic diuretic- used to treat cerebral edema by pulling water out of the extracellular space of the edematousbrain tissue, but it does not cross the blood-brain barrier. Morphine sulphate- used with ventilated clients to decreased agitation and control restlessness. Antiepileptic drug: Phenytoin -to prevent seizures. Surgical Craniotomy

are comminuted fractures in which broken bones are displaced inward. Depressed skull fractures carry a high risk of increased pressure on the brain, crushing the delicate tissue. Compound depressed skull fractures occur when there is a laceration over the fracture, resulting in the internal cranial cavity being in contact with the outside environment increasing the risk of contamination and infection. Complex depressed fractures are those in which the dura mater is torn. Depressed skull fractures may require surgery to lift the bones off the brain if they are placing pressure on it.
Approximately 25% of skull fracture are compound and merit immediate attention. The etiology is usually posttraumatic either following a traffic accident. Compound depressed fracture poses significant challenges to Neurosurgeon regarding their definite management. Cranioplasty of the front orbital are a major challenge to the surgeon because of the proximity to the globe, the sinuses, and the eyebrows and eyelids. Inadvertentlyfracture segments are removed in emergency to worsenthe cosmetic problem. Rarely, pulling out the fracturesegment may damage the vital are of the brain and leadto neurological deficit or may cause profuse bleeding, if it is in the vicinity of a major dural sinus. Concept: The concept of primary reconstruction was to close the defect

Depressed skull fracture

Depressed skull fracture.

A depressed skull fracture is a type of fracture usually resulting from blunt force trauma, such as getting struck with a hammer, rock or getting kicked in the head. These types of fractures, which occur in 11% of severe head injuries,

and preserve the anatomical barrier, to avoid a later cranioplasty and to prevent further complications like CSF leak, pneumocephalus, brainfungus and meningitis etc. The second reason for rigid fixation was to achieve good cosmetic results.

INDICATION MINIPLATE

FOR

TITANIUM

The titanium miniplate were used in case, (a) fracture over lying frontal region producing cosmetic deformity, (b)fracture involving the basifrontal region producing instability and (c) grossly comminuted fracture with significant bone loss.