Compound Elevated Skull Fracture: A Report of Two Cases and Literature Review

Abstract

Elevated skull fracture unlike depressed skull fracture is rare with few cases reported in the literature. Some cases have been reported from the South-western part of Nigeria. The aim of this report is to present an unusual aetiology for compound elevated skull fracture and to highlight the need for proper imaging and careful examination under anaesthesia to identify any dura tear and institute appropriate care. This is a report of 2 cases with compound elevated skull fractures. The first patient is a 2 year old boy who sustained injury following contact with a rotating ceiling fan blade while he was being lifted up by his uncle. Whereas the other patient, a 45 year old man, had his injury inflicted following assault. Examination findings in both patients revealed scalp laceration. The first patient had no focal neurological deficit but the second patient had significant focal neurological deficit. CT scan in both patients showed elevated skull fracture and evidence of dura tear. Both patients were worked up for surgery and had craniotomy, wound debridement, duroplasty and primary wound closure. They have been doing well since discharge. In conclusion, a rotating fan blade making contact with the head with downward pull produced elevated skull fracture in young children. Early recognition and treatment of this type of fracture would reduce the morbidity and mortality and improve outcome.