Incidence Of Skull Fractures Research Articles

Study of various types of road traffic accidents and associated skull injuries

Background: In the Road Traffic Accidents, the injury to the head and neck is the most important of all regional injuries. The nature of the internal damage may or may not be reflected in the superficial injury to the head and face.Objectives: To study various types of road traffic accidents and associated skull injuriesMethods: The sequence, frequency and distribution of the injuries is investigated in detail for all patients admitted to the hospital. Factors such as age, gender, injury and intoxication have been investigated. Both fatal and non-fatal accidents have been recorded. The data has been collected from PME reports and inquest reports, relatives and friends of the deceased.Results: Incidence of skull fractures is 397(84.3%) in males and 74 (15.7%) in females. M: F ratio is 5.36:1. Highest number of fractures are seen in temporal 100 (21%), then in occipital 56 (11.9%), frontal 19 (4%), least single bone fracture is seen in 9 (1.9%) cases. Temporal bone is the bone that is fractured the most, individually in 100 cases, around 246 (52.2%) cases survived for a duration in hospital and died in hospital, 185 (39.2%) cases died on the spot, 40(8.5%) cases died on the way to hospital.Conclusion: Effective interventions include designing safer infrastructure and incorporating road safety features into land-use and transport planning, improving the safety features of vehicles, improving post-crash care for victims of road crashes, setting and enforcing laws relating to key risks, and raising public awareness.

Profile of Fatal Head Injury Cases Autopsied at District Governament Hospital Mortuary

Background and Objectives: the study of profile of skull fractures is important as head being the most exposed and prominent part of body; it becomes most susceptible to injuries, as a result of criminal violence or accident. The present study was taken up to know the incidence of head injuries, age relationship,sex relationship, agent causing skull fractures, common skull bone fractures. Methodology: data in the current study was collected from the autopsy reports and from police inquest of all fatal skull fractures from the period of june 2012 to may 2014 irrespective of age and sex with history of death due to head injuries brought for postmortem examination to the department of forensic medicine & toxicology, al-ameen medical college mortuary and district hospital mortuary, bijapur between june 2012 to may 2014.Results: most common circumstance causing skull fractures are road traffic accidents in 77 cases (81.94 %). Male preponderance over females noted in this study with males constituting 80 cases (85.10 %) and females 14 cases (14.89 %). The most common age group affected was 21-30 years. Blunt force is the most common agent causing the skull fracture in 90 cases (95.74 %) and least is sharp in 4 cases (4.25 %). Among skull fracture comminuted fracture were seen in 46 cases (48.93%) , linear fracture in 38 cases (40.42%), depressed fracture in 8cases (8.5%) and sutural fracture in 1 case and gutter fracture in 1 case (1.06%) respectively. Temporal bone was the commonest bone fracture in 17 cases (18.08%). Conclusion: the study had concluded that incidence of skull fractures were common at the age group of 21-30 years, with male predominance, most common cases were those of RTA, cause of death that were given in majority of cases was that of Head injury as a consequence of injuries sustained.

Does every newborn need an imaging study after a fall? Case series and literature review

Objective This study examines the clinical and radiographic information from neonates who sustained a newborn fall (NF) to identify risk factors for the NF and the presence of skull fracture and intracranial bleed. In addition, published articles will be reviewed to provide data to assist in the evidence-based management of mothers after delivery and neonates after NF. Study design This is a retrospective chart review of neonates who sustained a NF in a level 4 NICU between 2016 and 2019. Results of imaging reports, maternal and neonatal clinical information, physical examination after fall, mode of delivery, time of day of fall, time between delivery and fall, feeding regimen, and maternal in hospital opioid use were recorded. Published reports containing imaging results and the incidence of skull fracture after NF were obtained by searching Pub Med from 2000 to 2019. Main outcome measures The main outcome of this study is to determine the presence and location of fractures and intracranial hemorrhage after a NF. Secondary outcome includes identification of clinical factors associated with the NF and presence of fractures. Student’s t-test was used for statistical comparisons. Results Twenty-one neonates sustained a NF and 83% were imaged by cranial CT. Skull fractures were identified by CT in 53% of neonates and ∼1/3 of infants had small intracranial hemorrhage. All infants were clinically stable and no neonate required neurosurgical intervention. Most NFs (73%) occurred between midnight and 8 AM and were associated with maternal sleeping while holding the infant. Conclusions Mothers should have increased monitoring and support especially the days after delivery from 11 PM to 9 AM to assess for maternal exhaustion and to prevent NFs regardless of opioid use. When indicated, low-dose rapid sequence CT scan rather than X-ray is preferred for evaluation of the neonate after a fall.

Prevention of head trauma and death in patients with head injuries: A forensic autopsy study

This forensic study investigated patients with head injury to find methods of preventing head trauma and death of patients with head injuries. Autopsy information of patients who died after experiencing blunt force trauma in the head owing to different causes was reviewed. In addition, the manners of the death of patients who had mild to moderate head injuries on admission were analyzed. The records of 68 adult patients (2008–2015) with skull fractures or traumatic intracranial lesions due to blunt force trauma were assessed in this study. These patients were divided into four groups according to the causes of trauma: traffic accidents (n = 20), simple fall (n = 18), fall from height (n = 23), and blow (n = 7). The demographic information (Glasgow coma scale [GCS] score on admission and current medication and fall histories), autopsy findings, and severity of the injury, as indicated by the Abbreviated Injury Scale and Injury Severity Score, were compared among the different groups. The causes of death of seven patients with mild (GCS score of 13–15) or moderate (GCS score of 9–12) head injuries on admission were analyzed. The numbers of patients with current medication, fall history, subdural hematoma, and head injury alone as the cause of death were significantly higher in the simple fall group. The incidence of skull fractures and the number of deaths from multiple head and trunk injuries were significantly higher in the traffic accident group. Of the seven patients with mild or moderate head injuries on admission, four and three died from the acute onset of a pre-existing condition and exacerbation of traumatic brain injury, respectively. These results indicate that preventions of simple falls in individuals with current medication or fall history may decrease the number of deaths due to simple falls, and patients with head injuries due to traffic accidents should be examined for coexisting trunk injuries; in addition, those with mild or moderate head injuries must be cautiously monitored for the onset of a pre-existing condition and exacerbation of traumatic brain injury.

Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma.

The purpose of this study was to determine the accuracy of "black bone" (BB) MRI for the detection of skull fractures in children with potential abusive head trauma. A total of 34 pediatric patients were evaluated for potential abusive head trauma. All patients had both a non-contrast head CT (HCT) with multiplanar reformatted images and3D volumetric reformatted images where available (gold standard) for fracture diagnosis and BB of the head with multiplanar reformatted images and 3D volumetric images. BB was performed using an ultrashort TE pointwise encoding time reduction with radial acquisition (PETRA) sequence at 1.5T or 3T. BB datasets were post-processed and 3D images created using Fovia's High Definition Volume Rendering® software. Two board-certified pediatric neuroradiologists independently reviewed the HCT and BB imaging, blinded to the findings from the other modality. Median patient age was 4months (range 1.2-30months). A total of 20 skull fractures in six patients (18% incidence of skull fractures) were detected on HCT. BB demonstrated 83% sensitivity (95%[CI] 36-99%), 100% specificity (95%[CI] 88-100%), 100% PPV (95%[CI] 46-100%), 97% NPV (95%[CI] 82-99%), and 97% accuracy (95%[CI] 85-99%) for diagnosis of a skull fracture. BB detected 95% (19/20) of the skull fractures detected by CT. A black bone MRI sequence may provide high sensitivity and specificity for detection of skull fractures in pediatric patients with abusive head trauma.

Severe traumatic brain injury and hospital acquired pneumonia: A study of correlation factors

Objective To investigate the incidence and risk factors of hospital acquired pneumonia (HAP) among patients with severe traumatic brain injury (TBI). Methods The clinical and imaging data of 114 adult patients diagnosed as severe TBI were retrospectively reviewed who underwent treatment at Department of Neurosurgery, Beijing Tiantan Hospital, from March 2016 to March 2017. Factors analyzed included the age, gender, mechanisms of injury, CT scan before admission, GCS (Glasgow Coma Scale) scores, pupil changes, tracheal intubation or tracheostomy, central nervous system (CNS) infection, duration of mechanical ventilation and antibiotic drug use. Comparison of variables between groups with tracheal intubation and tracheostomy, early and late tracheostomy were conducted. Results The incidence of HAP after admission was 23.8%. Past history of pulmonary diseases, tracheal manipulation, CNS infection, diffuse axonal injury were considered as risk factors of HAP. Patients in tracheal intubation group had significantly fewer days of ventilator use and shorter stay at hospital, lower incidence of HAP compared with tracheostomy group. Patients with early tracheostomy had lower incidence of skull fracture, shorter hospital stay and less expenses, while their incidence of HAP and outcomes were not significantly different from those with late tracheostomy. Conclusions Pulmonary diseases, related tracheal manipulation, CNS infection and diffuse axonal injury could be the risk factors for HAP in patients with severe TBI. Early tracheostomy might not reduce the risk of HAP, while it could significantly decrease the incidence of skull fracture, the length of hospital stay, antibiotic usage and medical expenses. Key words: Craniocerebral trauma; Pneumonia, ventilator-associated; Root cause analysis

A retrospective analysis of 374 casualties from the Nepal earthquake

Objective To analyze the feature of victims transported from Nepal Pokhara' s earthquake, and summarized the rescuing experiences got by the Chinese government medical team. Methods A total of 374 casualties from the 2015 Nepal ' s earthquake magnitude 8.1 transported to the Field Hospital of the Chinese government medical team were classified into four groups according to different causes of injury, and then retrospectively analyzed the types of injury, vital signs, severity of injury and causes of injury. Results Of 374 casualties, the average age was (30.1 ±12.4) years, and were divided into group A (n =154) in which casualties trapped under ruined buildings, group B (n =123) in which the victims had crushed injury during escaping with their lives, group C (n =58) in which the wounded had injury resulted from fall on the ground during fleeing for their lives and group D (n =39) in which the injury of casualties was caused by fall from high level. Of them, 273 patients (296 parts of body injured) suffered from fracture including 34 patients with severe multiple trauma. The average age in the group D (22.3 ±7.4 years old) was significant younger compared with the others (all P <0.05). The average age in the group C (48.4 ±13.3 years old) was significant older compared to the others (all P <0.05). The injury probability was higher for male in the group D (14.2% vs. 7.1%, χ2 =5.077, P =0.024) and the injury probability was higher for female in the group C (19.7% vs 10.8%, χ2 =5.635, P =0.018). The incidence of limbs fracture was highest (66.6%) in all 296 parts of body injured. The incidence of skull fracture in the group B (31.6%) was higher compared to the others (all P <0.05), and the incidence of spinal fracture in the group D (40.0%) was higher compared to the others (all P <0.05). There was no significant difference in the severe multiple trauma incidence between the group A and the group D (16.9% vs. 12.8%, χ2=0.381, P =0.537), but both group A and group D had significant higher incidence of severe multiple trauma compared to the rest two groups (all P <0.05). The wound debridement was the leading rate of treatment among variety of treatments (57.5%) and the plaster fixation was the second high rate of treatment (30.9%), and the wound infection was found in 25 patients (17.4%) at the first dressing among 144 patients with soft tissue laceration. After active and regular debridement, 72% patients' wound smear tests were negative 3 days later, and 100% were negative 7 days later. Conclusions The casualties treated by Chinese government medical team had relatively young average age, not very severe critical illness, and quite high rate of wound infection. The treatment of all kinds of fractures and open wound was a matter of critical importance. Although facing the challenge of incomplete set of medical equipment, the lacking of medicine and many other unexpected problems, the Chinese government medical team successfully fulfilled the mission with the prior experience accumulated from several domestic earthquake disaster rescue actions. Key words: Earthquake; Trauma; Mountain; Injury reason; Injury mechanism; Rescue; Nepal; Case-analysis

Computed tomographic pattern of traumatic head injury at a tertiary hospital in Ibadan, South-Western Nigeria: A 10 year review

Background: The World Health Organization has projected that by the year 2020, head trauma from Road Traffic Crashes (RTCs) alone will be the 3 rd leading burden of diseases in developing countries. Computed tomography (CT) is the imaging modality of choice in acute traumatic head injury evaluation and provides an excellent guide to the care of the head injured patient. Aim: The aim of this study was to evaluate the computed tomographic pattern of head injury over a decade. Materials and Methods: This is a 10 year retrospective and descriptive study carried out at the University College Hospital Ibadan, a premier tertiary health institution, which serves as a referral center for cities and towns in South-West Nigeria. All patients with head injury referred to the Radiology Department for cranial CT investigation between January 2003 and December 2012 were recruited into the study. Results: Males accounted for 75.3% of the 2142 head trauma cases with an approximate male to female ratio of 3:1. The mean age of the patients was 34.4 years, and the median age was 32 years (age range: 1-92 years). Patients <39 years accounted for 64.4% of the cases. RTC was the most common etiologic factor accounting for 1,318 head injury cases. Cases due to assault were least seen in 131 (6.3%) of the study population. Abnormal CT findings were present in 77.6% of cases. Intracranial hemorrhage was demonstrated in 1390 patients and was the most common finding. Intraaxial bleeds were present in 60.9%, and the incidence of skull fracture was also high (50.9%). Conclusion: RTC remains the leading cause of head injury but now occurring at an increasing and alarming rate. The most common abnormal CT finding is intraaxial bleeds, followed by skull fractures and extraaxial bleed in decreasing order. A combination of these findings was also frequently recorded.

The significance of incomplete skull fracture in the birth injury

Vaginal delivery is accomplished by the force of the labor overcoming the resistance forces of birth canal. During this process, the fetal head passes through the birth canal and the skull receives pressure on the lateral aspect, resulting in molding, the convex shaping of the cranium. Also, the infant's skull is compressed by the mother's pelvic bony structures. These forces may lead to skull fractures and brain injuries. The hypothesis by the authors is that many skull fractures of the newborn present as incomplete fractures. The bony skull of the newborn is histologically primary bone tissue and which is incomplete in its ossification process. During birth the pressure forces upon the newborn's skull is gradual in one direction, rather than a sudden impact, and therefore it is thought that the skull fracture would be an incomplete fracture. However, it is very hard to ascertain the presence of incomplete fractures especially in incompletely ossified skulls with plain X-ray studies, and therefore it is possible that the real incidence of skull fractures in the newborn are higher than reported in the current and past literature. It is also probable that the external forces upon the skull that are sufficient to cause skull fractures, would also lead to significant brain injury more frequently than actually observed, and subsequently contribute to development of many brain disease later in children. The authors of this study propose that very close examination should be conducted to find incomplete fracture, and increased efforts should be made to establish the presence of possible accompanied brain injuries in babies with incomplete skull fracture. The definitive diagnosis and treatment, as well as close follow up of patients with brain injury will assist the clinician in determining the causes of neurological diseases especially in those with previously unknown etiologies, which may be due to birth injuries. Assistance may be also afforded in the early treatment and prevention of such conditions.

Significance of vomiting after head injury

OBJECTIVESTo determine whether the presence and severity of post-traumatic vomiting can predict the risk of a skull vault fracture in adults and children.METHODSData were analysed relating to a consecutive series...

The spectrum of pediatric injuries after a bomb blast

The spectrum of pediatric injuries seen after a bomb blast is poorly documented. The pathophysiology of blast injuries differ significantly from other forms of trauma and typically result in large numbers of distinctly patterned injuries. On April 19, 1995, a truck bomb was detonated directly adjacent to the Alfred P. Murrah Federal Building in Oklahoma City, Oklahoma. A total of 816 adults and children were injured or killed as a direct result of the blast. Twenty infants and children were seated by the window of the second floor day care center at the time of the explosion. The injuries incurred by all children involved in the blast were studied. Nineteen children, 16 of whom were in the day care center, died as a direct result of the blast. The injury patterns among the 19 dead children included a 90% (17 of 19) incidence of skull fractures, 15 of those with cerebral evisceration (skull capping); 37% with abdominal or thoracic injuries; 31% amputations; 47% arm fractures, 26% leg fractures; 21% burns; and 100% with extensive cutaneous contusions, avulsions, and lacerations. Forty-seven children sustained nonfatal injuries with only seven children requiring hospitalization. The injuries sustained by the seven hospitalized children included two open, depressed skull fractures, with partially extruded brain, two closed head injuries, three arm fractures, one leg fracture, one arterial injury, one splenic injury, five tympanic membrane perforations, three corneal abrasions, and four burn cases (1 > 40% body surface area [BSA]). After a bomb blast, pediatric patients sustain a high incidence of cranial injuries. Fractures and traumatic amputations are common. Intraabdominal and thoracic injuries occur frequently in the deceased but infrequently in survivors.

Incidence of skull fractures in Olmsted County, Minnesota

Incidence of skull fractures in Olmsted County, Minnesota

Brain lesions detected by CT scans in cases of minor head injuries.

Since CT scans make it possible to demonstrate precise morphological and anatomicopathological findings, small brain lesions are frequently found on CT scans, in spite of the short duration of unconsciousness after head trauma. Thirty six out of approximately 500 cases which received CT examinations within two weeks after head injury were selected and analyzed. In these cases, almost all high or low density lesions were detected in the tip and/or base of the frontal and/or temporal lobes adjacent to the skull. Causes of the injury were traffic accidents (33.3%), falls on the floor or road (33.3%), and falls down stairs, out of beds, etc. (25.5%). Clinical manifestations before CT examinations were heaviness in the head or headache (36.0%), and nausea and vomiting (33.3%), but thirteen out of 36 patients had no symptoms or complaints. None of the 36 patients showed any neurological dysfunctions suggesting focal damages. Fourteen of the above-mentioned 36 patients (38.9%) had skull fractures and the remaining 22 (61.1%) did not, and there was no significant difference between the two. On the contrary, the incidence of skull fractures in cases in which CT scans were normal was 12.4% which was significantly different from the figure of 38.9% in patients with fractures and CT abnormalities. It is inferred that the deformation of the skull at the time of impact is one of the important factors in the development of brain contusions. To clarify the correlation between the duration of the initial unconsciousness and abnormal CT findings, 219 consecutive cases of head injuries underwent CT scans without considering their severity. Out of 171 patients who were conscious or lost consciousness in less than 10 minutes, 13 (7.6%) had small lesions in CT scans. Of 12 cases with a state of unconsciousness from 10 to 60 minutes in duration, three (25.0%) had abnormal CT findings. In all cases which were unconscious for more than 6 hours, brain lesions were detected by CT scans.

Computed tomography in child abuse head trauma

Forty-five head trauma cases from 177 child-abuse patients are reported. Intracranial injuries include acute epidural and subdural hematomas, subdural effusion, cerebral contusion, and atrophy (subdural effusion and cerebral contusion being most frequently seen). Incidence of skull fracture among the 45 patients is about 38%. Sixty-five percent of the 17 skull fracture patients also had intracranial injury, and 78% of the 28 patients with normal skulls had intracranial injury. CT should be the primary tool for evaluating child-abuse head trauma.