Causes
The possible causes of a skull fracture are many and varied, but in the beginning there is always an external force that exceeds the resistance of the bone. This force can act on a resting head or the head can move towards a solid object and collide with it. It is not uncommon to see a fractured skull after accidents in road traffic.
In a head-on collision with a car, for example, such high forces occur that the head hits the steering wheel or dashboard head-on and as a result the skull fractures. The same is of course possible on a bicycle, where the rider hits the ground or another object uncontrollably after an accident. If the head comes up first, a skull fracture is not unlikely at high speeds.
Skull fractures are becoming increasingly rare in road traffic due to protective measures such as airbags or helmets. Apart from traffic, the main causes of a skull fracture are accidents at home or at work. A fall from a ladder or scaffolding can, in the worst case, result in a fractured skull even at a relatively low height.Likewise, many sports where high speeds occur have an increased risk potential.
Diagnosis
At the beginning of each diagnosis, if possible, the cause of the accident and the observation of the injury from the outside are investigated. For example, an open skull fracture or a displacement of the bones can already be detected. The diagnosis of a skull fracture is then made relatively quickly with an image of the head.
X-rays can show a bone fracture. The problem here, however, is that a confusing number of bony structures overlap in the head region, making it difficult to localize the fracture precisely. Therefore, if a skull fracture is suspected, an examination of the head by means of computed tomography (CT), which also uses X-rays, is the first choice today.
This provides a very good representation of bone and allows a very precise description of the damage. Besides CT, magnetic resonance imaging (MRI of the head) plays an important role. It is not used routinely, but when damaged soft tissue is suspected.
In contrast to CT, MRI can be used to examine and assess brain tissue, nerves, muscles and also vessels very well. MRI of the head also provides very good images of cerebral hemorrhages that may occur as a result of the accident. In order to be sure whether fluid escaping from the nose or ears is cerebrospinal fluid, laboratory chemical tests can be carried out and the fluid can be clearly identified.
Then in some cases UV endoscopy is necessary to find the leaky spot. In addition to the diagnostics that can be carried out with technical aids, a rough neurological status should always be determined in the event of a skull fracture. Testing of nerve and brain function includes a test of consciousness and testing of motor skills and sensitivity.
Visual and hearing acuity should also be briefly checked. Therapy for skull fractures depends strongly on the type of injury and the affected area. A fracture of the nasal bone, for example, can in many cases be treated conservatively under observation without the need for surgery.
Similarly, a skull fracture of the calotte is not necessarily an indication for surgery, provided the fracture is not too large and no other structures are damaged. Nevertheless, in most cases a skull fracture requires surgical correction, especially when brain structures are also affected or the fracture parts are displaced or dented. In such cases, a neurosurgeon can fix the bone pieces with wires or screws so that the skull fracture heals well.
In the facial region, surgery is necessary in most cases, especially if the eyes are involved or nerves are restricted in their function. The absolute indication for surgery is a basal skull fracture with brain involvement. Torn vessels must be sutured and a possible leak to the cerebrospinal fluid space should be closed.
If a skull fracture or SHT is accompanied by bleeding to the inside, these bruises in the skull must be removed and the brain relieved. In most cases of skull fracture at the base of the skull, antibiotics are also given prophylactically to reduce the risk of infection of bones, brain or meninges. In addition to the causal therapy, pain therapy is also used. After treatment of the skull fracture, if permanent damage to the brain has occurred, in some cases subsequent rehabilitation may be necessary to relearn any skills that may have been lost.
