Compound Depressed Fracture Research Articles

Management of Compound Depressed Fractures over Venous Sinuses

Abstract Objective The aim of this study was to report our experience in the surgical treatment of compound depressed fractures over the venous sinuses with special highlights on the prediction and dealing with intraoperative sinus injury. Materials and Methods We conducted a retrospective review of all patients who underwent surgery for compound depressed fractures overlying the dural venous sinuses in our hospital between January 2019 and December 2021. Results A total of 34 patients were included in our study. The mean age of the patients was 19.85 years, most of our patients were males 27 (79.4%), and isolated head trauma was the most common mode of trauma (76.5%). The superior sagittal sinus (SSS) was distinguished as the most commonly involved venous sinus below the fractures in 28 patients (82.4%). An intraoperative tear in the sinus was found in 17 patients (50%), which was easily controlled with different methods. In two patients who had a severe head injury with a Glasgow Coma Scale (GCS) score of ≤8 associated with a fissure fracture crossing the sinus, there was a complete tear of the sinus followed by massive bleeding, which required sinus ligation. We lost both of them in following days. Conclusion In experienced tertiary neurotrauma centers, compound depressed fractures over the venous sinuses should be surgically elevated in most cases, taking into consideration that bleeding from the sinus can be controlled in most cases, and complete tear of the sinus with massive bleeding is the least scenario faced in reality and is usually associated with a severe head injury. If expert opinion favors the conservative approach, then close follow-up for months is recommended due to the high possibility of sinus thrombosis and intracranial hypertension, especially in children.

Primary Open Reduction and Internal Fixation of Isolated Compound Depressed Nasal Fractures.

The aim of this study was to assess the efficacy of primary open reduction and internal fixation (ORIF) utilizing the existing dorsal wound for the management of isolated nasal fractures characterized by significant depression and to determine its effectiveness in preventing the need for subsequent nasal revisions. A retrospective review was conducted on patients who underwent ORIF of nasal bone for isolated compound depressed nasal fractures from January 2018 to January 2024. The primary outcomes included the assessment of clinical and radiographic results postoperatively, focusing on nasal symmetry, projection, airway patency, and the incidence of secondary surgical interventions. The study included 15 patients, predominantly males (60%), with an average age of 39.33 years. The mechanisms of injury included motor vehicle accidents (40%), falls (26.7%), interpersonal violence (20%), and occupational injuries (13.3%). All patients were treated on the first (73.3%) or second day (26.7%) after the injury. All patients had satisfactory esthetic and functional outcomes and did not require secondary rhinoplasty. The hardware was removed in 4 patients (26.7%). Primary ORIF through an existing dorsal wound for significantly depressed isolated nasal fractures was effective in obviating the necessity for subsequent nasal revisions.

Primary cranioplasty for calvarial compound depressed fractures; 2 centers experience

IntroductionTraumatic brain injuries (TBIs) are among the leading causes of death and disability in younger age groups. Current guidelines to prevent infection in compound depressed fractures of the skull recommend fragment removal and debridement, and the cranial defect usually is left for a secondary cranioplasty. However, recent studies demonstrated no difference in infection rates between primary and secondary reconstruction. Herein we point out our preliminary experience using a single-staged approach to surgical management of open depressed skull fractures.MethodsThis study included 72 patients between Egypt and Saudi Arabia with compound depressed fractures of the skull that underwent primary cranioplasty either by elevation or by titanium reconstruction within the first 72 h post-traumatic brain injuries. We report surgery-specific characteristics and overall complications over a 12-month follow-up period.ResultsFifty-nine (82%) immediate primary cranioplasty patients were without complications. Twelve complications were seen in twelve patients. Infection accounted for only 2.8%, while the rest consisted of convulsions (6.9%), CSF rhinorrhea (4.2%), CSF leak, seroma, and re-operation (1.4%) each. One patient died after 20 postoperative days due to pulmonary embolism.ConclusionNeurosurgical expertise and readily available medical facilities within the civilian populations have significantly changed the traditional approach in calvarial CDF patients within the first 72 h post-trauma, where primary cranioplasty has proven to be a valid procedure with minimal morbidities compared to the traditional two-stage protocol.

Autograft cranioplasty for skull defects in children

BackgroundCranioplasty is a commonly performed neurosurgical procedure. Cranioplasty is a surgical repair of bony defects in the skull resulting from previous surgery or injury. The pediatric population differs from the adult population as the skull keeps growing and needs special consideration. Aim of the workThis study was conducted to report the experience of the University of Mansoura in children undergoing various bone autografts for cranioplasty over a period of four years. Patients and methodsThis retrospective study of hospital records of children undergoing cranioplasty at the Department of Pediatric Neurosurgery, Mansoura University Hospital between 2018 and 2022. Sex, age, cause of cranial defect, time since craniectomy, type of graft used, bone fixation, cosmetic outcome, wound healing, complications, and treatment of complications were reported. ResultsData from forty-two children were reported in this study. The most common indication for cranioplasty was trauma in twenty two cases 52 % (compound depressed fractures + growing skull fractures + decompressive craniectomy).The most common location was the frontal lobe in fifteen cases 35 %. In 47 %, the split calvarial graft was the most commonly used graft type. The highest percentage of cases showed no complications after follow-up (71 %). ConclusionAutograft cranioplasty in pediatric population had a 71 % success rate in our series with multiple different options including split calavarial graft, rib graft and repositioning of previously stored craniectomised bone flap. The choice between them depends on age of the patient and size of the defect.

The use of vancomycin powder in the compound depressed skull fractures

Background/aimCompound or open depressed fractures (CDF) is one of the urgent operations of neurosurgery, as it can result in complications of infection. This study is reported to investigate the effect of topical vancomycin powder to the infection rates in the compound depressed skull fractures which have been operated on. Materials and methodsThis present study was conducted on 46 cases with compound depressed skull fractures which have been operated on. Cases were divided into two groups according to the use of subgaleal topical vancomycin powder during the operation. The preoperative and postoperative CRP levels, localization of the fracture, hospitalization time, operation length, dural injury, pneumocephalus, and mortality rates have been examined. ResultsIn cases with dural injury and pneumocephalus, a statistically significant relationship was found between the use of topical vancomycin powder and the frequency of post-op infection (p < 0.001). It was observed that the incidence of postoperative infection was significantly higher in 12 (85.7%) cases with pneumocephalus and dural injury when vancomycin powder was not used. Also, it was observed that the post-operative infection level was significantly higher in fractures in the frontal and parietal regions without vancomycin powder(p < 0.05). ConclusionsThe use of subgaleal topical vancomycin powder is an option to reduce the infection rates and mortality, especially in the cases of compound depressed fractures, which is considered as a dirty wound and prone to infection. It is especially recommended in the presence of dural injury and pneumocephalus.

A Prospective Comparative Evaluation of Surgery and Conservative Treatment for Compound Depressed Skull Fractures

The Brain Trauma Foundation issued level III evidence guidelines for surgical management of compound depressed fractures. However, some patients undergo successful conservative treatment. This study compares these 2 treatment modalities. This prospective study included 67 patients with compound depressed skull fractures with surgical indications and a minimum follow-up of 6 months. Depressed fractures in front of the hairline (operated on for cosmetic reasons) and associated with significant intracranial injuries were excluded. Those who gave consent for surgery were included in the surgical group, and those who denied were included in the conservative group. The surgical group had 38 patients and the conservative group had 29. Both groups were comparable in mean age, gender, Glasgow Coma Scale score, head injury severity, depth of fractures, and follow-up duration. Focal neurologic deficits were observed in 19 patients at presentation and were higher in the surgical group. Mean hospital stay was significantly shorter in the conservative group. Mean Glasgow Outcome Scale score at follow-up was statistically similar in both groups (P= 0.13). Focal neurologic deficits improved equally in both groups (P= 0.67). The severity of traumatic brain injury (P= 0.004) and the presence of focal neurologic deficits (P < 0.001) affected the neurologic outcomes. The age, gender, mode of treatment (surgery vs. conservative), surgical site infections, and seizures did not affect neurologic outcomes. The overall complication rates were similar among groups (P= 0.50). New-onset focal neurologic deficits, seizures, and infection rates were not significantly different among the groups (P= 0.98, P= 0.72, P= 0.69). Conservative management has equivalent neurologic outcomes and complications compared with surgical management.

Iron Rod Penetrating Head Injury in a Child

AbstractCivilian penetrating brain injury (PBI) is a rare form of traumatic brain injury (TBI) and is rarer in the pediatric population. Pediatric PBI due to various objects has been reported in the literature. Pediatric PBI with an iron rod has not been previously described. We reported a case of civilian penetrating injury in a 6-year-old girl child patient who fell over a projecting iron rod at a construction site from a height of 6 to 8 feet. She was lifted off from the iron rod and taken to the emergency medical services. CT scan of the brain revealed linear intracerebral hemorrhage along the iron rod’s track with a depressed fracture. She underwent emergency surgery because of a compound depressed fracture. She recovered well from his injury without neurological deficit with an excellent clinical outcome.

Management of Compound Depressed Fractures Over Major Cranial Venous Sinuses

Background: Incidence of trauma increased both in developing and developed countries especially in congested cities because of high traffic flow. This makes it a worldwide health and social issue. Furthermore, depressed skull fractures occur over venous sinuses in 11% –18% of cases, representing a fairly large proportion of these cases. Objective: To characterize the demographic, clinical and radiological findings of patients with depressed fractures overlying cranial dural sinuses that we have faced in our institute at Sohag University Hospital. Patients and Methods: This retrospective and prospective study was conducted on 50 patients with compound depressed fracture over venous sinuses, which were treated either surgically or conservative at Sohag University Hospitals. Results: Despite surgical group included patients with neurological deficit and impaired level of consciousness compared to conservative group; surgical group had the same outcome as the conservative group. CNS infection was not recorded in both groups and the superficial infection was significantly higher in the conservative group. Mortality related to the treatment modality was not recorded in our study. Conclusion: Both surgical and conservative treatment of compound depressed fracture over major cranial venous sinuses had a good outcome as regards morbidity and mortality. Risk of CNS infection is not high but surgical treatment can significantly decrease the risk of infection compared to the conservative treatment.

Infection Rate in Pediatric Compound Depressed Fractures FollowingPrimary Replacement of Bone Fragments

AbstractBackground: Compound depressed fractures is one of thecommon neurosurgical emergencies. Children presenting withthis type of head injury, need careful and rapid decision toavoid lifelong morbidities as neurologic deficit. Surgery,according to most authors, is the gold standard in management,however, post-operative wound infection remains a seriouscomplication.Aim of Study: The purpose of this study was to identifyfrequency of infection in pediatric population with compounddepressed skull fractures managed by placement of bone chipsafter cleaning with betadine and antibiotic.Patients and Methods: This study included 41 patientsaged less than 16 years. All patients had Glasgow Coma Scaleof 15. Surgery was done within 24 hours following trauma.Full clinical examination, motor power assessment was andbrain CT scan was done to all patients. Bone fragments wereplaced after cleaning with betadine, saline and gentamicinantibiotic. Patients were assessed for wound infection followingsurgery for the next 3 month.Results: Patients' mean age was 7.8 years, 80.5% of themwere males. The site of the compound depressed fracture wasleft frontal in 36.6% of cases. Fractures were complicated bydural tear in 43.9% of cases. Fall from height was the com-monest mode of trauma in 41.5% of patients. Infection ratewas 7.3% of the cases.Conclusion: The risk of infection in pediatric compounddepressed fractures managed by placement of bone chips aftercleaning with betadine and saline with gentamicin antibioticin the first 24 hours following surgery was low.

Traumatic Fractures Involving Major Dural Venous Sinuses: A Reappraisal Study from the Tertiary Trauma Care Center in Nepal

Objective: The surgical management of compound depressed fractures overlying dural venous sinuses confers major challenges for the neurosurgeons. On one hand, the depressed fracture and associated compound wound herald the risk of venous occlusion and fatal brain swelling, on the other hand, the surgical attempt in managing them foresees major risks of bleeding and air embolism. Materials and Results: A retrospective analytical study was conducted from the hospital records pertaining to the cohorts of patients admitted with traumatic fractures overlying major dural venous sinuses. Among 45 patients included on our study, six patients were managed conservatively, and the rest 39 patients required surgical intervention due to compound depressed fractures heralding high risk of venous flow obstruction. The age of our patients ranged from 6 to 60 years with a high male predominance (77% vs. 22.22%).The most common mode of injuries was road traffic accidents in 66.67% (30/45) of cases. The most common location of depressed fracture was in the anterior third of SSS, seen in 57.77% of cases. The surgical complications were seen is 2.23% of cases, with the single instances of air embolism, profuse bleeding and cortical venous thrombosis seen respectively. The overall mortality seen in our study was 6.67%, whereas the operative mortality was only 4.45%. Conclusion: The refinement in the surgical nuances has now enabled us in managing depressed fractures overlying major dural venous sinuses with minimal risks of complications, thereby preventing the high risks of venous hypertension they otherwise invariably harbinger.

Depressed skull fracture: Prognosis of patients after conservative or surgical management

Introduction: The fracture of skull is considered as severe injury and have grave prognosis. It is mainly because of complications of the acute head injury affect the brain directly or indirectly. Compound depressed fractures are surgical emergencies and unless treated promptly and properly complications like meningitis, cerebral abscess and osteomyelitis of skull may occur. Objectives: to determine the causes of depressed fracture skull and its complications and also to find out various presentation and severity of depressed skull fracture and effective modality of management. Materials and Methods: A prospective study undertaken at department of surgery in coordination with emergency department. Detailed inquiry was done about history of demographic data, presenting symptoms and other diseases done. General, central nervous system examination, other systems examination and local examination were done thoroughly and documented. Patients were treated according conservatively and operatively as per decision taken by surgeon. Results: Out of total 100 patients, assault (43%) was most common, followed by vehicular accident (41%), fall of patients (15%) and fall of object on the patients (1%). Patients with severe head injury (GCS Conclusion: Conservative management is better in patients with CT scan suggestive of depressed skull fracture nor more than 10 mm and not intracranial hematoma. Patients with depressed skull fracture with more than 10 mm with severe head injury and associate hematoma are better managed operatively. Keywords: Depressed skull fracture, Operative management, Conservative management.

Delayed Neurological Deterioration after Depressed Fracture over Superior Sagittal Sinus: Our Experience with 13 Patients.

To present our experience in the diagnosis and management protocol of 13 patients with a depressed skull fracture over the superior sagittal sinus (SSS) who developed delayed neurologic deterioration. This retrospective study was conducted in the Neurosurgical Department, Assiut University Hospitals, between May 2012 and May 2017. All patients with a depressed skull fracture over the SSS were reviewed. Only those patients who were neurologically intact after trauma but suffered delayed neurologic deterioration were included in this study. Preoperative characteristics of age, sex, cause of trauma, type and site of the depressed skull fracture, and clinical presentation were reviewed and evaluated. Neuroimaging including brain computed tomography and computed tomography venography were evaluated. Of 612 patients with depressed skull fractures admitted to our department, 63 had the fracture segment on the SSS. Thirteen patients, nine males and four females, met the inclusion criteria (age range: 5-42 years). The most common cause of trauma was assault from others (seven patients). Eight patients had a compound depressed fracture; the other five fractures were simple. Interval between trauma and neurologic deterioration ranged between 4 days and 3 weeks. Clinical deterioration included decrease of consciousness, headache, blurred vision, and repeated vomiting. Deterioration of consciousness was seen in four patients. Eight patients had sixth cranial nerve palsy. Visual deterioration was seen in four patients. All the included patients were operated on for elevation of the depressed segment. Eleven patients improved; two patients who presented initially with visual deterioration did not improve. Their visual deterioration persisted after surgery. For both these patients, lumbar puncture revealed high cerebrospinal fluid (CSF) pressure. Clinical improvement followed the insertion of a thecoperitoneal shunt. Increased intracranial pressure (ICP) may follow a depressed fracture over the SSS. It may occur immediately after trauma or later. Surgical decompression with elevation of the depressed segment is indicated. Persistence of manifestations of raised ICP despite elevation of the depressed segment indicates the occurrence of an SSS thrombosis. CSF pressure should be measured to confirm the diagnosis and consider a thecoperitoneal shunt.

Venous Sinus Thrombosis Following Repair of Compound Depressed Fractures Overlying Sinuses

AbstractBackground: Traumatic dural venous sinus injury associ-ated with depressed skull fracture is one of the most dangerous complications of traumatic brain injury, because it may be complicated during repair by fatal venous bleeding or post-operatively with venous sinus thrombosis.Aim of Study: In this research we will evaluate the inci-dence and management of venous sinus thrombosis following repair of cases of traumatic compound depressed skull fractures overlying venous sinuses.Patients and Methods: This is a retrospective study of 40 cases of compound depressed fractures overlying dural venous sinuses, operated in the period between May 2015 to May 2016, all cases subjected to surgery for elevation of depressed skull fracture, follow-up ranged from 3 to 6 months.Results: In 22 cases (55%) the bleeding was controlled by direct gelfoam compression, in 10 cases (25%) the bleeding was controlled by direct stitching of the dural tear followed by gelfoam compression, in 6 cases (15%) the bleeding was controlled by pericranium duroplasty, 2 cases (5%) bleeding was controlled by free muscle duroplasty.Two cases (5%) developed complete obstruction of the venous sinus, the 2 cases were operated by pericranium duroplasty, both were early managed with anticoagulants, one of them later in the follow-up developed benign intracranial hypertension.Conclusion: Venous sinus thrombosis uncommonly occur after repair of compound depressed skull fractures overlying venous sinuses, early management with anticoagulation will result in good outcome, thrombi in sinuses frequently recanalize with time due to fibrinolysis.

Depressed Skull Fractures Overlying Dural Venous Sinuses: Management Modalities and Review of Literature.

To characterize the sociodemographic, clinical and radiological findings of patients with depressed skull fractures overlying cranial dural sinuses that we have faced in our institute. In addition, to explore the indications and choices for the surgical and nonsurgical management of such cases, and assess outcomes in these two treatment groups. We prospectively followed up a cohort of 34 patients with fractures over dural venous sinuses from January 2013 to December 2017. Twelve (35.1%) were simple depressed fractures (SDFs) and 22 (64.7%) were compound depressed fractures (CDFs). Eighteen patients (52.9%) were treated surgically, and 16 (47.1%) were treated conservatively. The mean age was 20.8 years. Thirty-two of the patients were males (94.12%). The mean time from trauma until hospital arrival was 3.8 hours, and the mean admission Glasgow Coma Score (GCS) was 13.7. Direct trauma was the most common mode of injury. Funduscopy was performed in 16 patients (47.1%), and magnetic resonance venography (MRV) in four patients (11.8%). Twenty-four patients (70.59%) had the fracture overlying the superior sagittal sinus (SSS). The mean length of hospital stay was five days, and the mean follow-up duration was 6.8 months. Twenty-eight patients (82.35%) had a good recovery. The majority of SDFs and some CDFs overlying dural sinuses can be managed safely without major surgical intervention. Conservation should be favored when the sinus is patent, dura intact, and bone displacement is insignificant in neurologically intact patients with an apparently clean wound. Otherwise, surgery should be considered. We also propose including a funduscopic examination and venogram as parts of the initial trauma work-up for these patients.

Craniofacial Trauma in Pediatric Patients Following Winnowing Blade Injury-review of Literature.

In developing countries, during the harvest season, winnower blade injuries occur very frequently in children and results in lifelong disability. Nine children were managed during 1 month, all resulting due to winnower blade induced craniofacial trauma. PubMed search for “fan blade injury” showed two case series and three case reports. In our study, 88% had compound depressed fracture; brain matter leak in 56%, cerebrospinal fluid (CSF) leak alone in 22%. 66.7% had injury involving the frontal bone. Two patients had eye injury with visual loss. Seven underwent debridement craniectomy, five augmentation duroplasty and three contusectomy. All had vegetable material, sand particles. Complications in 66.6% with two cases of CSF leak settled with lumbar drain, one case of CSF otorrohea, 22.2% of wound infection, 44.4% wound dehiscence requiring redebridement and suturing in five patients. Two patients had postoperative seizures, two patients had hemiparesis both improved. Two low Glasgow Coma Scale remained so on postoperative period. One case of subdural empyema needed debridement and duroplasty with glue. No mortality noted. These findings were consistent with previous reports. Follow-up at 1.5 months showed good functional recovery. Early surgery debridement, steps to minimize postoperative infections, identifying putative risk factors early in the management are the principles of a successful treatment regimen.

COMPOUND DEPRESSED FRACTURES;

Background: It is defined as fracture in which fractured fragment is elevatedabove the level of the intact skull. Objectives: To assess the outcome of patients with delayedrepair of compound depressed fractures. Study Design: Retrospective comparative crosssectional study. Setting: Civil Hospital, Karachi, Pakistan. Period: 01-01-2015 to 31-12-2016.Methodology: Sample size was calculated and sampling technique was non probability. Datawas recorded from patients files to computer and analyzed on SPSS version 21. Results: Themean age of study participants was 21 years ± 5. There were 14 (77.7%) male and 4 (22.2%)female patients in our study. The maximum time from injury to intervention was 84 hours. Mostpatients presented to the emergency department with compound depressed fractures due to fallor hit by blunt object (40%) followed by road traffic accidents (33.3%) and assault (26.7%). Mostcommon location of the compound depressed fracture was frontal bone involving right sideof the skull. All the patients were successfully managed with satisfactory outcome without anymajor complications. Conclusion: The authors conclude that repair of depressed compoundfractures in adults, if managed properly shows good outcome with less complications even withdelay of 6 hours to 84 hours from injury to intervention.

Efficacy and Safety of Using N-Butyl Cyanoacrylate in Cranial Fixation Following Trauma and Other Pathologies.

Skull bone fixation following different cranial surgeries is essential and should be rigid, simple and cheap. We describe our technique of cranial fixation using the adhesive cyanoacrylates. At the end of cranial and intracranial surgeries the craniotomy flap and bone pieces are returned, realigned and fixed using HistoacrylŽ (N-Butyl Cyanoacrylate) glue. The glue is applied all around the flap in 360-degree fashion. The adhesive material was used in 24 cases after different surgeries involving the calvaria of the skull. Patient age ranged from 1 month to 55 years. Seven cases presented with depressed fractures, 5 traumatic hematomas, and 2 cases after decompressive craniotomies for malignant middle cerebral artery (MCA) infarctions, and 10 cases operated for brain tumors. No skin or bone flap infections were encountered during the follow up period and fusion of the edges of bone flap was observed on follow-up imaging in most of the cases. Skull bone realignment and fixation using glue is a simple, safe, and inexpensive method. The operative procedure was not prolonged. Good cosmetic appearance and realignment and fusion of the bone flap were achieved. Further neuroimaging methods are not prohibited. Glue is suitable for the growing skull of children. Glue is also suitable in compound depressed fractures of the skull with possibility of infection.

Linear Frontal Bone Fractures - Clinical and Surgical Profile: A Retrospective Study

Background: Linear frontal bone fractures are common injuries in road traffic accidents. Pneumocephalus and CSF (cerebrospinal fluid) leak are both factors influencing their outcome. Persistent pneumocephalus and CSF leak are main indications for surgical treatment. Objectives: Surgical indications are rarely discussed in linear frontal bone fractures. We report results on patients with linear frontal bone fractures, clinical data, management, surgical indications and outcome. Methods: From 2011 to 2015, 121 patients were admitted to our institution with a diagnosis of frontal bone fractures (compound depressed fractures excluded). Fractures were classified into three types, Type A: fracture involving anterior wall of the frontal sinus; Type B: fracture involving posterior wall of the frontal sinus and Type C: fracture of frontobasal region without involving the frontal sinus. All patients were followed for more than 6 months. Results: A total of 112 patients were conservatively treated with standard pneumocephalus protocol. Nine patients underwent surgical intervention. The indications for surgery were the presence of persistent pneumocephalus in CT scan and persistent CSF leak. The presence of pneumocephalus or CSF leak in Type B patients sinus cranialisation with repair of the defect were the variables mainly influencing the outcome (P < 0.001). Conclusions: Frontal bone fracture needs careful attention to prevent its complications such as a CSF leak and meningitis. Patients need clinical and radiological evaluation. Patients with persistent CSF leak or pneumocephalus should always be treated surgically and others should be managed conservatively

Study Of 50 Cases With Craniofacial Trauma Who Experienced Head Injuries

Background: It has been shown that cranial injuries associated with facial fractures may cause a great risk of mortality and neurological morbidity, which mainly occurs in young adults. Aims and objectives: Study of the features of facial injuries associated with head injuries, discussing the management options and detecting the outcomes following craniofacial trauma. Methods: This is a retrospective study carried out at Imam reza and Shohada Hospitals. Radiographs and hospital data of 50 patients with craniofacial trauma between January 2013 and December 2014, managed at the Oral and Maxillofacial surgery department were gathered and analyzed. Results: The greatest number of the patients had 20 to 50 years old (68%) and most of them were male. (M/F ratio was 6.09:1). The most prevalent causes of the trauma in this study were the motor vehicle accidents (44%) and falling from height (36%), respectively. The most common bone fracture among the patients was the zygomatic bone fx (38.2%). Among the symptoms which the patients presented, Loss of the consciousness (52%) and headache (43%) showed the highest prevalence. Compound depressed fractures, contusions and intracranial hematoma were the leading causes of the surgical intervention for intracranial lesions. A high number of patients who have died in this study had associated systemic injuries. Displaced facial bone fracture were the indications for operation in facial fractures. Conclusions: The majority of the patients with craniofacial trauma were the adult males and the leading cause of trauma were road traffic accidents. A high number of the patients had mild head injuries and required only a conservational therapy. Keywords: head injury; craniofacial trauma; facial fracture

Split Calvarial Graft to Repair the Large Frontal Bone Defect

The ideal reconstructive material for cranioplasty is autogenous bone, however if it is not available the use of alloplastic materials is recommended. We present a case of 26-year-male patient who sustained compound depressed fracture of the frontal bone and associated anterior cranial fossa fracture following a road traffic accident. He was managed at hospital where the fractured bone fragments were removed but recently presented with watery discharge from nose (CSF rhinorrhoea) and cosmetic deformity of forehead. We describe the utilization of autogenous local frontal bone split calvarial graft for the reconstruction of the defect.