Early diagnosis and treatment of growing skull fracture

Abstract

Growing skull fracture (GSF) is a rare complication of pediatric skull fractures and causes delayed-onset neurological deficits and cranial asymmetry. Early treatment is pivotal to prevent those complications. The aim of this study is to highlight the early diagnosis and treatment of GSFs. Between January 2000 and June 2013; 6,916 children with linear fracture were treated in three separate hospitals. Inclusion criteria were: Patients who were diagnosed and treated within 30 days and had one or more following features: (a) 3 years or less age with cephalohematoma; (b) seizures immediate to the injury; (c) underlying brain damage; and (d) bone diastasis 4 mm or more. A review was retrospectively carried out to identify those patients who had early diagnosis and surgical intervention. Eighty-six patients met the inclusion criteria and all had magnetic resonance imaging (MRI) brain scans. Twenty-two patients had GSF, fall was the most frequent cause of injury and cephalohematomas the most common symptom. The most common injury site was the parietal region. Early surgical repair of dura and skull was associated with good outcomes. The patients aged 3 years or less with cephalohematoma, underlying brain damage, bone diastasis ≥4 mm on computed tomography (CT), and seizures immediate to the injury were high risk group for developing GSFs. Early diagnosis and surgical treatment of GSF can yield a good outcome.