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CMT > Skull Fractures > Flashcards

Skull Fractures Flashcards

1
Q

how do skull fractures occur?

A

when forces striking the head exceed the mechanical integrity of the skull

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2
Q

Skull Fractures

which bone is most likely to fracture? next 3 most likely?

A
  1. parietal
  2. temporal, occipital, frontal
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3
Q

Skull Fractures

most common fracture type? next 2 most likely?

A
  1. linear
  2. depressed, basilar
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4
Q

Skull Fractures

most common causes of head injuries

A
  • falls
  • assaults
  • MVCs
  • penetrating missiles
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5
Q

Skull Fractures

bones of the skull

A
  • frontal
  • ethmoid
  • sphenoid
  • occiptal
  • 2 parietal
  • 2 temporal
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6
Q

Skull Fractures

avg thickness of bones in adults

A

2-6mm
temporal region is the thinnest

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7
Q

Skull Fractures

immbolize what with any skull fracture associated w/ head injury?

A

c-spine and t-spine

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8
Q

Skull Fractures

what to do when pt arrives to ER w/ skull fracture

3

A
  1. identify & stabilize life threatening injuries
  2. protect and stabilize airway
  3. then assess for: altered mental status, focal neurologic deficits, scalp lacerations, bony step off, periorbital or retroauricular ecchymosis
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9
Q

Skull Fractures

what should you not do to scalp wounds?

A

probe them

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10
Q

Skull Fractures

dx

A
  • non-contrasted CT
  • MRI if suspecting vascular or ligament injury
  • NO BENEFIT of skull x rays
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11
Q

Skull Fractures

dx if basilar fracture is suspected

A
  • CT angiography to assess for vascular injury
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12
Q

Linear Skull Fractures

describe this fracture type

A

single fracture that extends through the entire thickness of the skull

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13
Q

Linear Skull Fractures

most often involve which bones?

A
  • temporoparietal
  • frontal
  • occipital
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14
Q

Linear Skull Fractures

clinical significance

A

minimal!

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15
Q

Linear Skull Fractures

when is there clinical significance?

A
  • if the linear fracture crosses the middle meningeal groove in the temporal bone or major venous sinuses
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16
Q

Linear Skull Fractures

why is it worrying if the linear fracture crosses the middle meningeal groove or major venous dural sinuses?

A
  • can cause significant extra axial bleeding (beneath the skull but outside the brain parenchyma)
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17
Q

Linear Skull Fractures

common presentation

A
  • if simple + closed: no neurologic sx
  • can have swelling over fracture site
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18
Q

Linear Skull Fractures

a minority of these patients develop what?

A

ICH

19
Q

Linear Skull Fractures

management

4 components

A
  • no specific intervention necessary if CT reveals no underlying brain injury or depressed fracture
  • emergent neuro consult if ICH
  • neuro checks
  • can observe in ED or admit for monitoring
20
Q

Depressed Skull Fractures

how to these occur?

A
  • occur when trauma drive a segment of skull below the level of the adjacent skull
21
Q

Depressed Skull Fractures

often involve injury to the?

A

brain parenchyma

22
Q

Depressed Skull Fractures

complications

3

A
  1. CNS infection
  2. seizure
  3. death
23
Q

Depressed Skull Fractures

what can you do but must be very careful?

A

palpate the depression! (often limited due to swelling)

24
Q

Depressed Skull Fractures

DO NOT do what

A

blindly probe the wound

25
Q

Depressed Skull Fractures

management

A
  • Prophylactic meds due to increased risk of infection (tetnus, abx, anti-convulsants)
  • admission (enruosurgery or non-operative management)
26
Q

Depressed Skull Fractures

when to send to OR

A
  • depressed more than the thickness of the skull
27
Q

Depressed Skull Fractures

when to manage non-operatively

A
  • no evidence of dural penetrations or complication on CT
  • if fracture is closed
28
Q

Basilar Skull Fractures

involve at least one what five bones?

5

A
  • cribiform plate of ethmoid bone
  • orbital plate of frontal bone
  • petrous and squamous portion of temporal bone
  • sphenoid bone
  • occipital bone
29
Q

Basilar Skull Fractures

most commonly occur through what bone?

A

temporal

30
Q

Basilar Skull Fractures

suspect what if temporal bone is involved?

A

epidural hematoma

31
Q

Basilar Skull Fractures

what artery/vein is the temporal bone located near?

A
  • middle meningeal artery/vein
32
Q

Basilar Skull Fractures

clinical signs

8

A
  1. periorbital ecchymosis (raccoon eyes)
  2. retroauricular ecchymosis (Battle’s sign)
  3. otorrhea (CSF leak from ear)
  4. rhinorrhea (CSF lead from nose)
  5. hemotypanum (blood behind TM in ear)
  6. Neurologic presentation (depends on location)
  7. CN deficits depending on location
  8. dural tear
33
Q

Basilar Skull Fractures

rare but significant complication

A

traumatic carotid cavernous fistula

34
Q

Basilar Skull Fractures

Management

A
  • surgical emergency if ICH
  • admit for observation (EVERYONE)
  • close neuro monitoring
  • CSF leaks should self resolve
  • glucocorticoids for CN palsies
35
Q

Elevated Skull Fracture

occur when?

A

the fracture fragment is elevated above the underlying skull

36
Q

Elevated Skull Fracture

which bone most commonly affected?

A

frontal

37
Q

Elevated Skull Fracture

associated with?

A

significant intracranial injury

38
Q

Elevated Skull Fracture

usually blank rather than blank

A
  • tangental
  • perpendicular
39
Q

Penetrating Skull Fracture

results of?

A
  • gun shots
  • stab wounds
  • blast injuries
40
Q

Penetrating Skull Fracture

complications?

2

A
  • significant brain injury
  • significant brain hemorrhage
41
Q

Anti-Coagulated Pts

what are pts on warfarin or clopidogrel at high risk of?

A

ICH

42
Q

Anti-Coagulated Pts

what to do with these pts regardless of skull fracture type?

A

admit for observation

43
Q

Anti-Coagulated Pts

what to do at first sign of neurologic deterioration

A

STAT non-contrasted CT of the head

44
Q

Anti-Coagulated Pts

what could you consider?

A

reversal of anti-coag status

CMT (72 decks)

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