Skull fractures

Question 1

head injury must be evaluated by what 2 imaging techniques?

what is most commonly used to evaluate head injury?

Answer 1

CT or MRI

CT without contrast*

Question 2

using ___ for evaluation of head injury has become obsolete

Answer 2

xray

radiograph

Question 3

occasionally, ___ patients can be evaulated with plain film radiograph to prevent exposure of high radiation doses given by a CT scan

Answer 3

pediatric

Question 4

basic radiographs of the skull

Answer 4

PA caldwell view
PA waters
AP townes view
BL lateral views

Question 5

what is the best radiograph imaging view to visialize the paranasal sinuses

Answer 5

PA waters view

Question 6

what is the most common skull fracture

Answer 6

linear skull fracture

80% of all skull fractures

Question 7

linear skull fractures are most common occuring in what skull bones

Answer 7

parietal and temporal bones

Question 8

what is typical presentation of linear skull fracture

Answer 8

• radiolucent lines that tend to cross sutures*
• radiolucent lines that appear more lucent that vascular grooves or sutures
• appear longer than normal impressions
• NO serrated edges like seen in sutures*

Question 9

linear fracture vs suture lines

Answer 9

linear - dark, straight, very thin

suture - grey, follows suture lines, jagged, wide

Question 10

depressed skull fracture is considered an open or closed fracture

Answer 10

open fracture

Question 11

depressed skull fractures always occur where due to high energy impact

Answer 11

cranial vault

Question 12

what is the best modality for diagnosis of depression fracture in the skull

Answer 12

CT - find out right now!

Question 13

if a depression fracture extends > __-__ cm then neurosurgical referral is needed

Answer 13

> 0.5 - 1 cm

Question 14

depression fractures are associated with what complications

Answer 14

epidural and subdural hematoma or hemorrhage

meningitis

pneumocephalus

CSF leak

Question 15

what is another name for ping pong fracture

Answer 15

pond skull fracture

Question 16

what is the difference from depression and ping pong fracture

Answer 16

depression - complete - may have fragments extending in to skull

ping pong - incomplete - continuous smooth inward indentation - no osseous fragments

Question 17

ping pong fractures are commonly seen in what population

Answer 17

new born infants during labor or forceps delivery or being dropped

Question 18

ping pong fractures that occur in new born infants may fracture without osseous fractures and periosteal break, similar to ___ fracture

Answer 18

green stick

Question 19

what does ping pong look like radiographically

Answer 19

continuous smoth indentation of skull calvaria

Question 20

sutural diastasis pathology

Answer 20

traumatic or non traumatic

related to rapid growth spurts

Question 21

what diastatic fracture may be seen with or without fracture

Answer 21

traumatic sutural seperation

Question 22

diastatic fracture diagnosis (cm/mm)

birth, 2, 3

Answer 22

birth - > 1 cm
age 2 - > 3 mm
age 3 - > 2mm

Question 23

what is best way to diagnose basilar skull fracture?

SIGNS?

Answer 23

clinically

not xray - very rarely seen!*

CSF rhinorrhea
otorrhea
battle sign* and raccoon eyes*

Question 24

where do basilar skull fractures most commonly occur

Answer 24

sphenoid and temporal bones

obscuration of sphenoid sinus

Question 25

basilar skull fractures in the sphenoid and temporal bones are best seen on what xray

Answer 25

lateral skull

Question 26

there is a high probability of what in basilar skull fractures?

Answer 26

intracranial hemorrhage meningitis tear of meninges

Question 27

what is best modality to view basilar skull fracture

Answer 27

CT

Question 28

what do you do with a basilar skull patient

Answer 28

medical emergency neurosurgery

Question 29

what are the complications of skull fractures

Answer 29

``` hematomas subarachnoid hemorrhage pneumocephalus meningitis leptomeningeal cyst ```

Question 30

epidural hematoma can cause what

Answer 30

increased intracranial pressure cerebral edema subfalcine herniation or infratentorial herniation

Question 31

what is difference between epidural and subdural hematoma on CT

Answer 31

epidural - lentiform shape subdural - crescent shaped

Question 32

leptomeningeal cysts are mostly found in?

Answer 32

pediatric skull | < 3 years old

Question 33

why does leptomeningeal cyst develop

Answer 33

meningeal tear | interposition of leptomeninges

Question 34

what will leptomeningeal cyst lead to

Answer 34

seizures hydrocephalus meningitis

Question 35

what is the most common of all facial bone fractures

Answer 35

nasal bone

Question 36

why are nasal fractures often missed

Answer 36

large regional swelling

Question 37

nasal fractures may present with other fractures like

Answer 37

blown out fracture

Question 38

how do nasal fractures occur

Answer 38

direct impact by hand, steering wheel, etc

Question 39

most nasal fractures are induced with a __ force component that may displace in this direction

Answer 39

lateral force

Question 40

xray provides __% sensitivity via lateral nasal view

Answer 40

80%

Question 41

what modality is preferred to view a nasal fracture

Answer 41

CT - other fractures may have occurred - blown out fracture of eye

Question 42

undisplaced vs displaced nasal fractures

Answer 42

undisplaced - no treatment displaced - difficulty breathing and septal necrosis - surgery

Question 43

blow out fracture of the orbit is due to what

Answer 43

high impact to the globe

Question 44

most blow out fractures will result ___ fracture that will force the orbital fat and inferior rectus muscle into the ___ sinus this is called

Answer 44

infra orbital maxillary sinus trapped door fracture

Question 45

50% of blow out fractures may involve the __ wall of the orbit

Answer 45

medial wall - lamina papyreca fracture*

Question 46

best modality to view blowout fracture

Answer 46

CT - exclude other injuries - optic nerve damage and trapped inferior rectus

Question 47

what view will show opacification of the maxillary sinus for a blow out fracture

Answer 47

waters skull

Question 48

what is the second most common facial fracture

Answer 48

tripod fracture

Question 49

how does tripod fracture occur

Answer 49

blow to malar region of the face

Question 50

what are specific fracture points of tripod fracture

Answer 50

zygomatic arch orbital proccess of zygomatic bone and superior lateral maxiallary wall maxillary process of zygomatic arch

Question 51

complications of tripod fracture

Answer 51

trismus, trapped temporalis muscle, loss of sensory over V2

Question 52

what xray view could you see a tripod fracture

Answer 52

waters skull

Question 53

what is best modality for viewing tripod fracture

Answer 53

CT

Question 54

what is a complex fracture of the mid face that potentially separates mid facial structure from the skull base

Answer 54

lefort fracture

Question 55

what is essential to diagnose lefort fracture - what bone/piece of bone

Answer 55

lateral pterygoid plate

Question 56

what are the different grades of lefort fractures

Answer 56

lefort 1 - horizontal maxillary fracture that separates the upper teeth* from the face lefort 2 - separates nasal and medial wall of orbits with upper teeth from the face lefort 3 - cranial facial separation* - fracture line that goes straight across the eyes

Question 57

best modality to view lefort fracture

Answer 57

CT

Question 58

mandibular fractures are common fractures most often due to what

Answer 58

assault

Question 59

most mandibular fractures are unilateral or bilateral?

Answer 59

unilateral

Question 60

what is involved 30% of the time and is considered the most common location of fracture

Answer 60

mandibular condyle

Question 61

best modality for mandibular fracture

Answer 61

CT best for COMPLEX fractures but could see something on xray

Question 62

what are other places for mandibular fractures

Answer 62

``` condyle 30% angle 25% body 25% ramus 3% coronoid process 2% ```