Management of Depressed Skull Fractures: Selective Conservative Management of Non Missile Injuries

Abstract

Objective: To determine the outcomes of management of depressed skull fractures. Study Design: Descriptive Study Place and Duration of Study: Department of Neurosurgeries, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat and Chandka Medical College Hospital, Larkana from 1st March 2020 to 28th February 2021. Methodology: Eighty patients of both sexes were enrolled in this study. Patients were aged between 12-70 years of age. Patient’s detailed demographics age, sex and body mass index were recorded. Diagnosis of skull fractures from closed head injury patients were undergone for CT scan Depressed fracture of more than 5 mm, cosmetically disfiguring fractures and fracture over the sinuses were operated. All the patients were given prophylactic antibiotics and anticonvulsants. Patients were followed for 4-months. Outcomes were assessed by Glasgow Coma Scale (GCS). Results: Fifty five (68.8%) patients were males and thirty five (31.2%) were females with mean age was 18.21±7.32 years and mean body mass index was 20.04±3.14 kg/m2. Road traffic accident (56.25%) was the most common cause of the injury followed by fall from the height 25 (31.25%). The compound fractures have 48 (60%) and simple fractures were 32 (40%). Surgery was done among 70 (87.5%) cases and 10 (12.5%) patients were conservatively treated. Among these 50 (62.5%) patients were completely recovered. Cerebrospinal fluid leak was the most common complication and was found in 13 (16.25%) cases. Conclusion: The use of antibiotics and anticonvulsants had effective results during peri-operative periods to avoid infection and epilepsy. The initial stage of operation is particularly necessary when the fracture is larger than 5mm. Cerebrospinal fluid leaks occur after surgery as the most common complication. Keywords: Depressed skull fracture, Non-missile injuries, Cerebrospinal fluid