Ch55 Skull fractures

Question 1

How do you classify skull fractures?

Answer 1

Closed (simple fracture) vs open (compound fracture)

Question 2

Which open fractures do you operate on?

Answer 2

Depression > thickness of the skull Dural penetration ICH needing evacuation Depression >1 cm Frontal sinus involvement Infection or gross contamination Gross cosmetic deformity

Question 3

What surgery is recommended for depressed skull fractures?

Answer 3

Elevation of bone fragmentes and debridement of skin edges. Repair of dural lacerations.

Question 4

Is there any evidence that elevating a skull fracture affects post-traumatic seizures?

Answer 4

No

Question 5

What structures may be disrupted with longitudinal temporal bone fractures?

Answer 5

Along the EAC and potentially leads to disruption of the ossicular chain

Question 6

What structures may be disrupted with transverse temporal bone fractures?

Answer 6

Perpendicular to EAC through the cochlea and may stretch the geniculate ganglion causing CN7 and 8 deficits

Question 7

What should be given to all patients with CSF leak following skull base fracture?

Answer 7

Pneumovax

Question 8

What is the difference between proptosis vs exopthalmos?

Answer 8

Proptosis means the eye ball is pushed forward Exopthalmos means the eye ball is in the right place but the surrounding structures are not

Question 9

Why check sensation of the forehead with frontal sinus fractures?

Answer 9

Supratrochlear / supraorbital nerve injury

Question 10

When is the frontal sinus radiographically visible?

Answer 10

8 years

Question 11

How is the frontal sinus approached surgically following trauma?

Answer 11

Bicoronal incision Forehead skin crease / eyebrow incision

Question 12

What does cranialisation of the frontal sinus mean?

Answer 12

Removal of the posterior wall and stripping of mucosa down to the frontonasal duct. Any residual mucosa may form a mucocele. The sinus can be packed with fat / muscle / gel foam etc and covered with periosteum.

Question 13

What are Le Fort fractures?

Answer 13

Maxillary fractures: >1 - Above the upper teeth >2 - Across the maxilla to the top of nasion >3 - Across the top of the orbits separating the face from the skull

Question 14

What are the HU of air?

Answer 14

-1000 (remember Fat is -40, CSF is 0; Blood is 60-80 and bone is >500)

Question 15

Which skull fractures should you give antibiotics for?

Answer 15

Open skull fractures

Question 16

What radiological sign suggests pneumocephalus?

Answer 16

Mt Fuji sign

Question 17

What proportion of skull fractures are simple, linear calvarial fractures in children?

Answer 17

90%