English

Abstract

BACKGROUND Depressed skull fractures (DSFs) cause wide range of injuries to the cranium and underlying structures, which influence the morbidity, mortality, and prognosis of the patient. This study was done to obtain a baseline clinical data regarding the management of such patients in Eastern part of our country. METHODS This prospective study was conducted in Assam Medical College and Hospital, Dibrugarh, from June 2016 to May 2017. Patients with depressed skull fractures fulfilling inclusion and exclusion criteria were included. After initial clinical evaluation, patients were put in conservative and surgical treatment groups. Surgical procedures were performed as per indication and intra-operative findings were recorded. All the patients were evaluated with regard to clinical findings, treatment provided, complications, outcome and other clinical variables during the hospital stay and follow up period. RESULTS A total of 65 patients out of the 1274 patients admitted for head injury were taken up for this study. Most patients were in the age group of 20 - 40 years. Male to female ratio was 5.5:1. The commonest mode of injury was road traffic accident followed by assault and others. Most common presenting symptom was brief loss of consciousness followed by post traumatic amnesia, ENT bleeding, seizures etc. Most commonly involved bone was frontal bone and most were compound fractures. At the time of presentation, 58.5 % of patients had Glasgow Coma Scale (GCS) score of 13 - 15, 33.8 % patients had a GCS score of 9 - 12 and 7.7 % had a GCS score of 3 - 8. Surgical intervention was required in 25 patients and rest received conservative treatment. Two patients expired during hospital stay. At the end of 3 months 78.46 % patients had good recovery, 6.1 % had moderate disability and 6.1 % patients had severe disability. CONCLUSIONS DSFs carry specific clinical features and problems which require individualised attention and care. These types of head injuries can be managed with good outcome in a peripheral government centre run by a single neurosurgeon. KEYWORDS Head Injury, Traumatic Brain Injury, Depressed Skull Fracture