Skull Bone Fractures Research Articles

Artificial Intelligence Application in Skull Bone Fracture with Segmentation Approach.

This study aims to evaluate an AI model designed to automatically classify skull fractures and visualize segmentation on emergent CT scans. The model's goal is to boost diagnostic accuracy, alleviate radiologists' workload, and hasten diagnosis, thereby enhancing patient outcomes. Unique to this research, both pediatric and post-operative patients were not excluded, and diagnostic durations were analyzed. Our testing dataset for theobserver studies involved 671 patients, with a mean age of 58.88 years and fairly balanced gender representation. Model 1 of our AI algorithm, trained with 1499 fracture-positive cases, showed a sensitivity of 0.94 and specificity of 0.87, with a DICE score of 0.65. Implementing post-processing rules (specifically Rule B) improved the model's performance, resulting in a sensitivity of 0.94, specificity of 0.99, and a DICE score of 0.63. AI-assisted diagnosis resulted in significantly enhanced performance for all participants, with sensitivity almost doubling for junior radiology residents and other specialists. Additionally, diagnostic durations were significantly reduced (p < 0.01) with AI assistance across all participant categories. Our skull fracture detection model, employing a segmentation approach, demonstrated high performance, enhancing diagnostic accuracy and efficiency for radiologists and clinical physicians. This underlines the potential of AI integration in medical imaging analysis to improve patient care.

Intracranial Haemorrhage After Decompressive Craniectomies for Trauma: Role of the Skull Clamp

Background: High Intracranial Pressure (ICP) is the most frequent cause of death and disability after severe Traumatic Brain Injury (TBI); in Europe, 33% of patients with TBI require neurosurgical intervention. Decompressive Craniectomy (DC) represents the extreme surgical treatment; although it is regarded as a relatively simple surgical procedure, it is often accompanied by many complications, including Extradural Hematoma (EDH) associated with an overlying fracture on the contralateral side. It presents an incidence of 5-12%, but Singh et al., analysing 2108 DC performed without the skull clump, estimate it to be about 0.48%. Any authors have indicated the relationship between EDH after DC for trauma in patients showing skull fractures and the use of this Head Immobilisation Device (HID). Materials and methods: We have retrospectively analysed all patients who underwent frontotemporoparietal DC and bifrontal DC after TBI at Venice Angel Hospital during a 5-year and six-month period (January 2017-June, 2022). All patients showed skull bone fractures at CT brain scan, associated with clinical and neuroradiological signs of increasing ICP. For each patient, we analysed: age and sex, neurological status: GCS at the moment of trauma and before surgery, pupillary size and form before and after surgery; neuroimaging evolution; the timing and DC. DORO© Mayfield skull clump was used in all cases. Results: Our surgical cohort counts 20 patients with M/F 3:2 and an average age of 47±17. 16 patients underwent urgent surgery (primary DC), and 4 were operated on after an overage of 50 hours of observation (secondary DC): 90% of patients experienced frontotemporoparietal DC and 10% bifrontal DC. Postoperative CT brain scan showed enlargement of brain contusion in 4 patients (20%); EDH in 4 patients: 2 in the side of skull fracture contralateral at DC, 1 contralateral at DC and skull fracture, 1 occipital in the side of fracture homolateral at DC; SDH in 2 cases, both homolateral at DC. For 3 patients, surgical treatment of EDH was necessary following DC. Conclusion: Our patients showed a higher probability of developing remote-site EDH; other typical complications presented the same or slightly higher frequency of occurrence. Considering the high risk-benefit ratio of skull bone application, we suggest adopting safer HID, such as surgical adhesive tape or a horseshoe headrest.

Pattern of Skull and Facial Bone Fracture in Craniomaxillofacial Trauma Associated with Traumatic Brain Injury: A Retrospective Analysis at Tertiary Hospital

Abstract: Trauma is one of the primary causes of death during the first four decade. Craniomaxillo-facial (CMF) trauma has become a common presentation in emergency departments of hospitals. The most presentation of CMF trauma includes skull and facial bone fracture and traumatic brain injury (TBI). This study aimed to obtain the pattern of skull and facial bone fracture in craniomaxillofacial trauma associated with traumatic brain injury. This was a retrospective study conducted on 501 patients from January 2020 to December 2021. Demographic data included age, sex, length of stay (LOS), and Glasgow coma scale (GCS). The results showed that from the total 501 patients with skull and facial bone fracture with or without traumatic brain injury, 406 (81%) were males and 95 (19%) were females. The age range of the patients was between 2 years and 86 years (mean±SD 33.9±18.2). The most common patient affected age ranged from 21 to 30 years. The average of LOS was 7.2±5.7 days (0-33) and the mean of GCS was 10.2±4.2. Based on types of cases, there were 232 cases (60%) of skull and facial bone fractures accompanied by TBI; 154 cases (40%) of only skull and facial bone fracture; and 339 (59.5%) cases of only TBI. In conclusion, the distribution of TBI increases in those with skull and facial bone fractures. On the other hand, the distribution of TBI is more common without fracture. Hence every skull and facial bone fracture must be carefully evaluated clinically and radiologically to rule out any underlying TBI. Keywords: skull and facial bone fracture; craniomaxillofacial trauma; traumatic brain injury

Clinico-Epidemiological Study of Fatal Head Injuries in an Autopsy

Introduction: Head injury is a significant public health problem worldwide. Traumatic head injury is a leading cause of death and disability in children and adults in their most productive years. The morbidity and mortality due to head injury is on the rise and is one of the prime importance in today’s medical practice. Objective: To assess the clinico-epidemiological study of fatal head injuries in an autopsy. Methods: The present study was conducted of the Department of Forensic Medicine &amp; Toxicology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January to June 2022. Total 250 patients included in this present study. We selected only fatal head injury cases due to mechanical violence. However, we included severe facial injury cases too as these cases were associated with head injury. But, the present study doesn’t involve crushed head injury or survived cases, referred or LAMA cases brought in the hospital. Results: Maximum cases were seen in the age range of 21-30yrs, 57 cases (22.8%). Maximum cases were seen amongst males, 196 cases, 78.4%. The commonest causes of fatal head injuries are Road Traffic Accident (RTA) cases. Other important causes of fatal head injuries are fall from height, assault &amp; railway accidents. External head injuries were mainly seen on frontal and parietal regions. Amongst the scalp injuries lacerations were very common seen in 114 cases, 36.19%. Skull bone fractures were frequently seen in fatal head injury cases. Presence of skull bone fractures are associated more frequently with fatal complications. Though linear fractures are common in general we observed the comminuted fractures as the commonest type of skull fractures in fatal head injury cases, seen in 73 cases, (58.4%). Depressed fractures were less common in fatal cases. Involvement of cranial fssa was seen in 108 cases. Linear type of fractures both transverse and horizontal type was more common seen in 66 coases amongst the 108 cases of cranial fossa involvement i.e. 61.11%. Involvement of middle cranial fossa was high seen in 45 cases of the 108 cases i.e. (41.66%). Presence of comminuted skull bone fractures is associated with higher rate of mortality. Conclusion: Most of the cases were due to road traffic c accidents and males are more prone to get Head injury. Other important causes of fatal head injuries are fall from height, railway accidents and assaults in descending order. To reduce the morbidity and mortality it’s high time for the concerned authority to take appropriate actions.

Severe neonatal birth injury: Observational study of associations with operative, cesarean, and spontaneous vaginal delivery.

To determine the association of successful and unsuccessful operative vaginal delivery attempts with risk of severe neonatal birth injury. We conducted a population-based observational study of 1 080 503 births between 2006 and 2019 in Quebec, Canada. The main exposure was operative vaginal delivery with forceps or vacuum, elective or emergency cesarean with or without an operative vaginal attempt, and spontaneous delivery. The outcome was severe birth injury, including intracranial hemorrhage, brain and spinal damage, Erb's paralysis and other brachial plexus injuries, epicranial subaponeurotic hemorrhage, skull and long bone fractures, and liver, spleen, and other neonatal body injuries. We determined the association of delivery mode with risk of severe birth injury using adjusted risk ratios (RR) and 95% confidence intervals (CI). A total of 8194 infants (0.8%) had severe birth injuries. Compared with spontaneous delivery, vacuum (RR 2.98, 95% CI 2.80-3.16) and forceps (RR 3.35, 95% CI 3.07-3.66) were both associated with risk of severe injury. Forceps was associated with intracranial hemorrhage (RR 16.4, 95% CI 10.1-26.6) and brain and spinal damage (RR 13.5, 95% CI 5.72-32.0), while vacuum was associated with epicranial subaponeurotic hemorrhage (RR 27.5, 95% CI 20.8-36.4) and skull fractures (RR 2.04, 95% CI 1.86-2.25). Emergency cesarean after an unsuccessful operative attempt was associated with intracranial and epicranial subaponeurotic hemorrhage, but elective and other emergency cesareans were not associated with severe injury. Operative vaginal delivery and unsuccessful operative attempts that result in an emergency cesarean are associated with elevated risks of severe birth injury.

ANALYSIS OF DEFECTS IN DIAGNOSIS AND FORENSIC MEDICAL ASSESSMENT OF SKULL BONE FRACTURES

Determining the age of skull bone fractures, especially flat fractures, is a challenging task for forensic medical expertise, as these fractures don't always heal properly due to poor alignment of their edges.&#x0D; Aim of the work. To investigate diagnostic defects and forensic medical expert defects that complicate the assessment of skull bone fractures by analyzing the archive database of the Main Bureau of Forensic Medical Examination of the Ministry of Health of Ukraine for the years 2017-2021.&#x0D; Materials and methods. The material consisted of 928 forensic medical commission examinations of traumatic brain injuries conducted at the Main Bureau of Forensic Medical Examination of the Ministry of Health of Ukraine from 2017 to 2021.&#x0D; Statistical indicators were used: mean values, standard deviation (M±ϭ), frequency of cases (N), confidence interval (Р±95%СІ), Student's criterion for relative values (t) to assess the statistical significance of differences between fractions (p&lt;0.05).&#x0D; Results. Diagnostic defects of skull fractures by physicians included: insufficient detailing of fracture description in medical documentation, unreliability of soft tissue injury description, inadequate use of neurovisualization methods, incorrect recording of trauma circumstances in medical records, and incomplete description of neurological symptoms. The main expert errors in affected individuals were the absence of correlation between skull bone fractures and intracranial injuries and soft tissue head injuries, while in corpses, there was incorrect description of skull fracture morphology.&#x0D; Conclusion. The use of additional neurovisualization methods and a comprehensive approach correlating all head injuries can improve forensic medical assessment of skull bone fractures.

Abordagem cirúrgica em correção de fissura na gnatoteca em um cisne-negro (Cygnus atratus, Latham, 1790) - Primeiro relato de caso

ABSTRACT The black swan (Cygnus atratus, LATHAM, 1790) is a bird kept as an ornamental in zoos. Because of their long beaks they tend to have a reserved prognosis in musculoskeletal disorders such as beak trauma, secondary to skull bone fractures, presenting irreversible lesions. The aim of this report is present a clinical surgical innovation in the repair of a black swan’s gnathotheca fissure with the application of non-conventional materials used. It was observed that one of the swans kept in a zoo display area had difficulty feeding, with associated weight loss. It was observed tissue loss and a lacerative lesion in the caudal sublingual region of its beak. The lesion was corrected by a separate simple suture in the cranial region of the beak and with a x-clamping using steel surgical wire and the application of dental resin in the distal region to perform a sustentation bridge in the beak end-gap. After 12 days, the animal was able to feed again and remained perfectly adapted to the restoration, reestablishing the anatomical and physiological function of its beak.

Impairment of the balance of angiogenic and neurogenic polypeptides of the oral fluid in fractures of the maxilla

Introduction. Fractures of the maxilla are characterized by such features as the close location of vital anatomical structures, the visual organ, as well as the aesthetic importance of this area of the face and the presence of risk of serious complications. The aim of the work was to estimate the level of angiogenic factors in the oral fluid: vascular endothelial growth factor A (VEGF-A), vascular endothelial growth factor D (VEGF-D), placental growth factor (PIGF), platelet-derived growth factor BB (PDGF-BB) (VEGF-A, VEGF-D, PIGF, PDGF-BB) and neurotrophins: nerve growth factor (NGFb) and basic brain-derived neurotrophic factor (BDNF) in orbital maxilla fractures. Materials and methods. A single-center, open-label, prospective case-control study was conducted in which 10 patients an upper jaw fracture of the maxilla (study group) and 10 practically healthy volunteers (comparison group) were examined. Along with clinical-instrumental and laboratory examination, patients were also examined for the content of VEGF-A, VEGF-D, PIGF, PDGF-BB, NGFb and BDNF in oral fluid by multiparametric fluorescent analysis with magnetic microspheres (xMAP technology, Luminex 200, USA). Results. The content of VEGF-A, VEGF-D, NGFb did not differ significantly between trauma patients and healthy practically volunteers. The content of PIGF-1 and PDGF-BB was markedly elevated in maxillary fracture, with the latter concentration being 12-fold higher than in the comparison group. Discussion. The results suggest that such injuries are accompanies by an imbalance of angiogenic and neurogenic polypeptides, manifested by increased levels of placental growth factor, platelet-derived growth factor and basic brain-derived neurotrophic factor. Conclusions. The study of the vascular remodeling and neuroprotection is important not only for extensive skeletal and craniocerebral trauma, but also for relatively local trauma – skull bone fracture in the orbit.

Retrospective Study of Pattern of Skull Fractures in Different Medicolegal Autopsies

Skull fractures occurred in RTAs, Assaults and other cases are the most common cause for hospitalization, disability, financial loss and death of the individual. Skull fractures are of various types i.e., linear, comminuted, depressed, hinge etc. Some of the skull fractures may cause rupture of dura mater and injury to brain matter thereby, causing permanent neurological damage and death. In this present study, we focused on the pattern of skull bone fractures involved in various manners like Accidental, Homicidal, Suicidal, also pattern of distribution among male and female, age wise distribution, time of death in a day, and also discussed about any other associated injuries that contributes to cause of death. 165(92%) skull fractures are observed in accidents, 141(78%) cases involve linear fracture. region wise distribution most commonly involved is base of skull region alone in 63(35%) cases commonly seen in fall from height cases, parieto-temporal and base of skull together 36(20%) cases seen in road traffic accidents, temporal and base of skull region 14(7.8%). In other associated injuries commonly involved intracranial haemorrhages and scalp contusions

The Association between Skull Bone Fractures and the Mortality Outcomes of Patients with Traumatic Brain Injury.

Introduction Skull fractures are often found in patients with traumatic brain injury (TBI). Although skull fractures may indicate greater force impact and are associated with local or diffuse brain injuries, the prognostic value of skull fractures remains unclear. This retrospective study aimed to assess the association between skull fractures and mortality in patients with TBI. Methods This study included 5,430 TBI patients registered in the trauma registry system from January 2009 to December 2018. Clinical and demographic data including age, sex, trauma mechanisms, comorbidities, Glasgow Coma Scale (GCS) score, abbreviated injury score (AIS)-head, injury severity score (ISS), and in-hospital mortality were acquired. Multiple logistic regression and propensity score matching were used to elucidate the effect of skull fractures on mortality outcomes of TBI patients. Results Compared to TBI patients without skull fracture, patients with skull fractures were predominantly male, younger, had lower GCS upon arrival at the emergency room, and had higher AIS-head, ISS, and in-hospital mortality. The patients with skull fracture had 1.7-fold adjusted odds of mortality (95% confidence interval (CI): 1.27–2.25; p < 0.001) than those without skull fracture, controlling for age, sex, comorbidities, and AIS-head. Additionally, the propensity score-matched analysis of 1,023 selected paired patients revealed that skull fracture was significantly associated with increased 1.4-fold odds of risk for mortality (95% CI: 1.02–1.88; p=0.036). Conclusions Using a propensity score-matched cohort to attenuate the confounding effect of age, comorbidities, and injury severity, skull fracture was identified as a significant independent risk factor for mortality in patients with TBI.

A STUDY ON PTERION IN ADULT DRY HUMAN SKULL BONES IN RAYALASEEMA POPULATION

Introduction: The knowledge of the variations of pterion &amp; its surgical anatomy are important for surgeons in operating the elds. This study also contribute additional information as skull bone fractures in infancy &amp; early childhood which may be associated with large inter sutural bones giving false appearance of fracture radiologically. 100 dry human skulls Materials &amp; Methods: which were obtained from the Departments of Anatomy, SVIMS - SPMCW; SV Medical college, Department of Anthropology, SV University, Tirupati; RIMS Medical college, Kadapa. Results: The sphenoparietal type of variety is seen in 71%, Frontotemporal - 20 %, Epipteric - 6 %, Stellate - 3%. The knowledge of location of pterion and its types in relation to important internal Conclusion &amp; Key Message: landmarks are really very essential for the neurosurgeon in their routine surgical approach.

Iris ensata Thunb: Review on Its Chemistry, Morphology, Ethno Medical Uses, Phytochemistry and Pharmacological Activities

Medicinal plants are mainly used as herbal medicine and play an essential role in primary health care, ethno-medicine system and production of appropriate drugs. Due to this multi-usage, trade network demand for the different medicinal species can extend to national as well as international boundaries. As only little studies are done on this plant, the purpose of current review is to make accessible up-to-date information on, botany, morphology, ecological biodiversity, therapeutic uses, phytochemistry and pharmacological activities on diverse parts of Iris ensata Thunb. The plant Iris ensata Thunb belongs to the family Iridaceae. It has been praised by the physicians of all times as a panacea and is broadly used in a huge number of disases. It heals up the chronic ulcers and absess, useful in insect bite, burns, vitiligo, weakness of muscles, itching and dandruff. It is emmenagogue, anti-inflammatory, anti orchitis, used in cold cough, in all humours, pneumonia, dyspnoea. The egesta accumulated in the chest are attenuated and resolved by Irsa, it is emetic and purgative. Ibne Sina recommends its efficacious actions in strengthening the wisdom and intellect, cures head injuries skull bone fractures, phlegmic and hot swelling. Ibne Baitar quoted that it is useful in tooth ache, dyspnoea, spleenomegaly, rigidity of uterus, flatulence, it is abortifacient, anti tussive. The fermentation with sosan is benifecial in endometritis, adenitis and hard swelling. Its efficacy in dyspnoea, asthma, thorasic pain, hydropes, jaundice, haemorrhoids, liver complaints, and sciatica. Root of Iris ensata Thunb are reach source of glycosides steroids, resins, proteins, phenolic compounds and also tannins. Flowers of this plant also contains anthocyanin 5-0-glucosyltransferase (R2) and anthocyanin-flavone e.g. malvidine 3KGaC5G, petunidine 3KGac5c, delphinidine 3RGac5G, petunidine(R2) . The epigeal parts of this plant contain mangiferin(R) and leteolin C-glycosides. This review highlights the traditional, ethnobotanical, phytochemical, pharmacological information available on Iris ensata, which might be helpful for scientists and researchers to find out new chemical entities responsible for its claimed traditional uses. Keywords: Iris ensata Thunb, Phytochemistry, Pharmacological activity, Ayurveda, Medicinal uses

Pattern and Outcome of Traumatic Brain Injury, Addis Ababa, Ethiopia: A Cross-sectional Hospital-based Study.

Traumatic brain injury (TBI) is the leading cause of death and disability in young adults in the world. This study assessed clinical characteristics and in-hospital outcomes among traumatic brain injury patients presenting to Addis Ababa Burn, Emergency, and Trauma hospital. A cross-sectional hospital-based survey was conducted at AaBET hospital from January 01/2020 to April 30/2020. Data were collected using structured questionnaires from the trauma registry and patient chart. The collected data were analyzed using statistical software SPSS v 25.0. Among the 304 traumatic brain injury patients, 75% were males with a mean age of 30.4 + 15.7, and 59.2% came from the Oromia region. Road traffic injury was responsible for 45% of the cases, of which pedestrian struck accounts for 52.2% of the cases. Only 50 (16.4%) patients arrived below 02 hours. 201 (66.1%) patients had mild traumatic brain injury the rest had moderate to severe traumatic brain injury. Skullbone fracture (linear, DSF, & BSF) was the most common (n=157, 63.1%) followed by intracerebral lesions (DAI, brain contusion, & ICH) (n=140, 56.5%). Forty-three (14.1%) patients were intubated. 45(14.8%) cases had a neurosurgical intervention. The mortality rate of severe, moderate, & mild TBI were 25%, 8.0% & 2.0% respectively with an overall mortality of 5.6%. This study showed road traffic injury was the commonest cause of traumatic brain injury which affected young age groups. There was a delayed presentation to AaBET hospital Emergency. The mortality rate was lower than other Ethiopian hospital studies.

An epidemiological study of fatal head injury cases in a sub urban region of Chennai: A prospective study of 350 autopsy cases

It is a prospective study of 350 fatal head injury cases brought during the study period extending from Jan’2016 to Dec’2017 admitted and treated in our tertiary health care center. The incidence of fatal head injury is growing with increasing number of high speed vehicle, more mobility of the public and urbanization. In short, it is the single most common cause of morbidity and mortality in emergency wards. Maximum cases were seen in the age range of 21-30yrs, 89 cases (25.42%). Maximum cases were seen amongst males, 281 cases, 80%. The commonest causes of fatal head injuries are Road Traffic Accident (RTA) cases. Other important causes of fatal head injuries are fall from height, assault &amp; railway accidents. External head injuries were mainly seen on frontal and parietal regions. Amongst the scalp injuries lacerations were very common seen in 149 cases, 35.90%. Skull bone fractures were frequently seen in fatal head injury cases. Presence of skull bone fractures are associated more frequently with fatal complications. Though linear fractures are common in general we observed the comminuted fractures as the commonest type of skull fractures in fatal head injury cases, seen in 77 cases, (57.03%). Depressed fractures were less common in fatal cases. Involvement of cranial fssa was seen in 113 cases. Linear type of fractures both transverse and horizontal type was more common seen in 71 coases amongst the 113 cases of cranial fossa involvement i.e. 62.83%. Involvement of middle cranial fossa was high seen in 47 cases of the 113 cases i.e. (41.59%). Presence of comminuted skull bone fractures is associated with higher rate of mortality.

Association of clinical and social factors with risk of fracture in children with atopic dermatitis.

Children with atopic dermatitis (AD) have multiple risk factors for accidental fractures, injuries that can lead to significant morbidity and mortality. However, little is known about the factors that mediate the relationship between AD and fracture in children. Our purpose was to examine the association of AD with fracture and to identify potential mediating factors. This retrospective cohort study examined children with and without AD from a longitudinal matched cohort database of 353,040 children registered in the national health insurance service and participated in the national health-screening program of Korea. We defined AD using medical claims and medication prescription records. We investigated accidental fracture events between the index date and the end of follow-up in a propensity score-matched cohort. Pre-specified subgroup analyses considered fractures in four different regions of the body. The mediating effects of 10 possible clinical factors (including the use of antihistamines and systemic corticosteroids) and social factors (including nutritional status and parental safety awareness) were determined. There were 145,704 participating children, 20% with AD and 49% girls. Fractures occurred in 6,652 of the children with AD (23%, mean age: 64.6±29.2months) and in 24,698 of the control group (21%, mean age 65.0±28.9months). Children with AD had an 8% greater risk of fracture events overall (adjusted relative risk [aRR]: 1.08, 95% CI: 1.05-1.10). In subgroup analysis, AD was related to increased rates of skull and facial bone fracture (aRR: 1.09, 95% CI: 1.04-1.14), for trunk including vertebrae (aRR: 1.58, 95% CI: 1.22- 2.05), and for distal limbs (aRR: 1.11, 95% CI: 1.07-1.15). However, the relationship with proximal limb fracture was insignificant. Duration of systemic corticosteroid prescription was the largest mediating factor, followed by duration of antihistamine prescription, and infant feeding practices. In particular, the duration of systemic corticosteroid prescription was significantly associated with fracture events (incidence: 20.1% at the 25th percentile and 23.6% at the 75th percentile; difference: 3.4% [95% CI: 2.8-4.0%]). Children with AD were related to increased fracture events. The key factors with mediating effects were systemic use of corticosteroid and antihistamine. Infant feeding practices had weaker mediating effects.

A Case of Delayed Tension Pneumocephalus in a Patient Undergoing Facial Cosmetic Surgery.

There has been a recognizable surge in cosmetic surgery in recent years, partly influenced by social media, and the easy accessibility to such medical procedures. As with all types of surgery, the risks of complications are real, and in this specific setting, they tend to occur in a younger age group. Here, we discuss a rare complication and subsequent presentation of tension pneumocephalus, following an episode of cardiac arrest in a 58 year old female, during elective cosmetic-facial surgery. Typically, pneumocephalus develops when there are skull or facial bone fractures, and presents characteristically with leakage of cerebrospinal fluid from the ears and/or nose. The absence of the typical clinical signs and the lack of a clinical history or radiologically evidence of skull or facial bone fractions, may result in a delayed diagnosis, permanent brain injury and death. Awareness of such an unusual complication is therefore crucial when considering any surgery to the head and face (including cosmetic surgery), or following prolonged resuscitative efforts, which may well develop days after the inciting event.

Evaluation of ultrashort echo-time (UTE) and fast-field-echo (FRACTURE) sequences for skull bone visualization and fracture detection – A postmortem study

Background and PurposeCT is considered the modality of choice in the assessment of the skull due to the fast and accurate depiction of bone structures. Nevertheless, MRI has evolved into a possible alternative due to optimal soft tissue contrast and recent advances with the ability to visualize tissues with shortest T2 times, such as osseous structures. In this study we compare skull bone visualization and fracture detection across two MRI sequences to CT as reference standard. Material and MethodsTwenty subjects underwent CT and MRI with less than 72 h between examination. The MRI protocol included a 2D ultrashort echo time (UTE) and a 3D multi-echo in-phase fast-field-echo (FRACTURE) sequence. Independent raters evaluated qualitative characteristics and fracture detectability in different skull subregions (skull vault, skull base and viscerocranium). Interrater and intermodality agreement was evaluated by calculating intraclass coefficients (ICC). ResultsFRACTURE ICC indicated a good agreement in all subregions (ICC = 0.83 – 0.88), whereas UTE had excellent results calculated in the skull vault and viscerocranium (ICC = 0.91 – 0.94). At the skull vault, both MRI sequences received an overall good rating (UTE: 2.63 ± 0.42 FRACTURE. 2.81 ± 0.32). Fracture detection using MRI sequences for the skull vault, was highest compared to other subregions. ConclusionsBoth MRI sequences may provide an alternative e.g. for surgical planning or follow up exams of the osseous neurocranium; although, at the skull base and viscerocranium bone visualization with MRI bone imaging sequences perform inferior to CT standard imaging.

Deaths Caused by Epidural Hemorrhage and skull base fracture Due Blunt Force Trauma

Epidural hematom is one of the most common types of intracranial bleeding due to skull fractures. Epidural hematom is the accumulation of blood and blood clots between the dura mater layer and the skull bone. Epidural hematomas can occur in anyone and any age. Epidural hematomas occur as a result of head trauma, which is usually associated with skull bone fractures and blood vessel lacerations. A very prominent symptom is that consciousness decreases progressively. Patients with this condition often appear bruised around the eyes and behind the ears. Often also visible fluid that comes out in the nasal passages or ears. Reported a case at the Department of Forensic and Medical Sciences Of Bhayangkara General Hospital TK II Medan City, explained that at a written request from the Padang Lawas Resort Police. The victim was a 14-year-old male student. From the results of external examination found bruises on the head and forehead, On examination in the discovery of blood absorption on the inner scalp, found blood clots on the surface of the thick membrane of the brain, fractures the base of the skull. From the results of external and autopsy concluded the post mortem interval is 24 to 36 hours.and the cause of death is Epidural Hemorrhage due to fractures of the skull due to blunt force trauma on the head.

Post-traumatic carotid cavernous fistula: A case report

A carotid cavernous fistula is an abnormal connection between the carotid artery and cavernous sinus which is a rare and sight threatening complication of craniofacial trauma. We report a case of a 36-year-old man with history of road traffic accident, flail chest, on mechanical ventilation who developed redness and progressive swelling of right eye. On evaluation, he was found to have right-sided conjunctival chemosis, pulsatile proptosis, and loud bruit on auscultation over right eyeball. Non-contrast computed tomography revealed multiple skull bone fractures with prominence of right-sided cavernous sinus and superior ophthalmic vein. Contrast enhanced magnetic resonance imaging with angiography revealed bulky cavernous sinus with tortuous right superior ophthalmic vein suggestive of right carotid cavernous fistula. Carotid cavernous fistula should be considered as a differential diagnosis for a critically ill patient with history of trauma developing swollen red eyes as the typical signs and symptoms cannot be assessed in patients on mechanical ventilation. The timely diagnosis and prompt treatment can save vision and can improve the outcome.

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 &amp; 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.