Compound elevated skull fractures: Review of literature

Abstract

Introduction: Compound elevated skull fractures (CESF) are rare traumatic injuries. To date, only 27 cases have been reported.Methods: The authors report three cases of CESF managed at their institute. All were middle-aged males. The mechanism was assault by sharp-edged objects in two and road traffic accident (RTA) in one case. One underwent simple suturing; debridement and decompressive craniectomy was done in the remaining two cases. Good and poor outcomes were noted in one case each, while one died. A literature review was performed to analyse all cases of CESF reported in English literature.Results: Including this one, a total of 30 cases were analysed. Mean age was 25.2 years, of which seven were aged < 18 years. There were 12 mild, five moderate, 11 severe HI cases and two cases were not detailed. Underlying injuries were seen in ~ 2/3 of cases. All, except two cases, underwent definitive surgery in the form of debridement with/without haematoma removal. Good-to-excellent outcomes were noted in 2/3 cases. There were 6/30 (20%) deaths noted. CNS infections and poor admission GCS were associated with increased mortality rates.Conclusions: CESF are rare injuries. Early surgery in the form of debridement with broad-spectrum antibiotic coverage is recommended to prevent infectious complications and improve outcome. Outcome is dependent on three main factors—admission GCS score, intactness of duramater and post-operative CNS infections.