Cranial fractures are among the most serious injuries. Such violations of the integrity of the cranial bones occur after severe strokes on the head and are often accompanied by brain damage. Therefore, these injuries are life-threatening. And even with a favorable outcome, they have serious consequences for the patient's health. It is very important that first aid in case of head injury is provided in time. This will help prevent a fatal outcome. But in any case, the treatment of such injuries is very long and requires a complex rehabilitation.
Features of skull fractures
Craniocerebral injuries are very common, especially in young and middle age. They cause about half the deaths among all injuries. This is due to the fact that a violation of the integrity of the cranial bones often leads to compression or damage to the brain and blood vessels. In addition, the skull has a very complex structure. A lot of bones are connected by seams, they have different structure and thickness. Some bones are permeated with blood vessels or have air-bearing cavities. Distinguish facial and brain departments of the skull. It is in the brain that injuries occur most often.
The features of fractures of the cranial bones are that when an external injury is damaged it may not be noticeable. In fact the arch of a skull consists of internal and external plates, between which the spongy substance is located. The inner plate is very fragile, so when it strikes it is damaged most often, even without damaging the integrity of the outer plate.
The causes of such injuries
Cranial fractures arise from the application of a large force. They are often exposed to people of young and middle age, leading an active life or doing sports. And also alcoholics, drug addicts and representatives of criminal structures. It is possible to single out such reasons, according to which there are fractures of the skull:
- Strong blows to the head with a hard object;
- Falling from a height;
- car crashes;
- gunshot wound.
There are two mechanisms for obtaining such an injury: direct and indirect. When a bone breaks in the place of application of force - this is a direct fracture. So usually there are injuries of the cranial vault. Damaged bones are often pressed inside and damage the meninges. With an indirect fracture, the effect is transmitted from other bones. For example, when falling from a height to the pelvis or legs through the spine, a strong impact is transmitted to the base of the skull, often leading to its fracture.
Symptoms of skull fractures
The further condition of the patient depends on how correctly the first aid was given in case of craniocerebral trauma. With any strong impact in the head area, one must suspect the possibility of a fracture of the skull bones. Sometimes such a trauma is not accompanied by clearly visible symptoms. But there are also special signs on which it is possible to determine not only the presence of a fracture, but sometimes the site of its localization and damage to the meninges.
- The main symptom of a skull fracture is a violation of consciousness. It can be a syncope or a coma, loss of memory, confusion of thoughts, hallucinations.
- In addition, fractures of the skull are always accompanied by severe headaches, dizziness, nausea.
- If the brain and nerve fibers are damaged, there is a violation of sensitivity, paresis and paralysis.
- If, as a result of a fracture, the brain stem is affected, breathing may be difficult, blood circulation is impaired.
- When the base of the skull is fractured, haematomas around the eyes or in the region of the mastoid process are often a characteristic symptom . There may be bleeding with impurities of cerebrospinal fluid from the nose, ears.
- A very serious injury is a fracture of the temporal bone. It causes severe dizziness, impaired coordination of movements, nausea, hearing loss, paralysis of the facial nerve.
Classification of cranial fractures
Trauma of cranial bones can be different. They are classified by the nature of the fracture, the location of localization, the severity of the lesion. Different parts of the skull can be affected. According to the nature of injury, there are three types:
- The most severe is a comminuted fracture, which can damage the meninges and vessels;
- The depressed fracture also has serious consequences, because with it the bones of the skull are pressed inward, which causes brain crushing;
- Linear fractures are considered to be harmless, since no displacement of bone fragments occurs, but they can cause vascular damage and the appearance of bruising;
- Very rarely there is also a hole fracture arising as a result of a gunshot wound, as a rule, such a trauma is incompatible with life.
In the place of damage, a fracture of the temporal bone, occipital or frontal, is distinguished. They are related to trauma of the cranial vault. If the base of the skull is damaged, it causes the appearance of cracks in the facial bones, they spread to the orbit, nose bridge and even the auditory canal. In addition, fracture of the bones of the skull can be open or closed, single or multiple. The condition of the patient depends on the severity of the injury, the degree of damage to the meninges and vessels, as well as on the timely provision of medical care.
Fracture of the cranial vault
It arises from a blow to the scalp. Therefore, the main symptom of such a trauma is a wound or bruise in this place. But the difficulty of diagnosing this trauma is that the inner plate of the cranial bone is damaged when it strikes, which is outwardly almost invisible. The patient can even come to consciousness, but gradually the symptoms of brain damage will increase. Fracture of the cranial vault may occur for various reasons, most often - with impact. People with alcohol and drug intoxication are especially susceptible to such traumas. Indirect effects, for example, when falling on the pelvis, may be accompanied by a fracture of the base of the skull. In this case, the patient's condition is especially severe, and the trauma can result in a fatal outcome.
Fracture of base of skull
Survival in such trauma depends on timely medical care. Fracture in this place can be independent or accompany the trauma of the cranial vault. In addition, there is a fracture of the anterior, middle and posterior cranial fossa. Such trauma, depending on the place and severity, is accompanied by bleeding from the nose and ears, the outflow of cerebrospinal fluid. A characteristic symptom of a fracture of the anterior cranial fossa is bruising around the eyes. With such injuries, all the senses of the patient suffer: sight, hearing, smell, coordination of movements are impaired. A very serious injury is a fracture of the base of the skull. Survival is about 50%.
Diagnosis of injuries
With any craniocerebral injury, a check is performed to exclude a fracture. In addition to interviewing the victim or his attendants about the circumstances of the injury, the doctor examines the patient. The sensitivity, the presence of reflexes, the pulse and the reaction of the pupils to light are evaluated. An x-ray of the skull is also made in two projections. To confirm the diagnosis, the results of magnetic resonance and computed tomography, brain puncture and echoencephalography are used. Such a study should be carried out even in the absence of visible consequences of trauma, since after an impact only the inner plate of the bones of the skull may be damaged.
Features of skull fractures in children
Despite the confidence of many that the cranial bones of the child are stronger, such traumas often occur in babies. And their diagnosis is difficult, and the consequences are usually more serious. A skull fracture in a child is dangerous because immediately after the injury the victim can feel good. This is due to the inadequate development of the frontal lobes and other parts of the brain. Consequences are manifested later: a strong increase in pressure, loss of consciousness, vomiting, anxiety, tearfulness. A special feature of skull injuries in children is multiple linear cracks, divergence of seams and bone impressions. Rarely, than in adults, there are fragmentary fractures, bruises and hemorrhages. But the complications can be just as serious: epilepsy, hydrocephalus, developmental lag, visual and hearing impairments often develop.
When getting a head injury, it is very important how quickly the victim will receive medical care. Often his life depends on this. While the victim is not delivered to the hospital, it must be laid on a hard surface without a pillow, fixing the head with soft objects. If he is conscious, then he can lie on his back. At fainting of the victim it is necessary to turn on his side, fixing his head with pillows so that he does not choke when vomiting. It is desirable to remove all jewelry, glasses, dentures, to unbutton clothes. The injured person must be provided with free air access.
If the trauma on the head is bleeding, a sterile bandage is applied on it, you can put ice, but you can not touch or press on the place of damage. It is not recommended to give the patient any medication before the doctor's arrival, as, for example, narcotic analgesics can cause a breathing disorder. As soon as possible the victim needs to be taken to the doctor, even if he is conscious and feels normal. After all, traumas of the skull never pass without a trace. And without timely treatment can cause serious consequences.
Features of treatment of skull fractures
The victim with a craniocerebral trauma should be in a hospital. Depending on the severity and the location of the lesion, he may be assigned conservative or surgical treatment. Be sure to comply with bed rest. The head should be slightly elevated to reduce leakage of cerebrospinal fluid. In case of trauma to the base of the skull, lumbar puncture or drainage is needed. For fractures of moderate and mild severity, drug therapy is used. The patient is prescribed such drugs:
- Non-steroidal anti-inflammatory;
- Antibiotics to prevent purulent infection;
- Nootropic and vasotropic drugs;
- Drugs to improve the cerebral circulation.
If the fracture is severe, for example splintered or depressed, with multiple bone injuries, then surgical treatment is performed. It is necessary to remove fragments and areas of necrotic tissue, as well as accumulated blood. During the operation, nerve and vessel damage is also eliminated. Surgical treatment is used if purulent infection has begun, which is not eliminated by conservative therapy.
The consequences of such injuries
If the skull fracture is linear, without bone displacement and large hematomas, and if purulent infection has been avoided, then the recovery prognosis is usually favorable. But the fracture of the skull is not always without complications. The consequences of such a trauma can be very serious:
- Meningitis, encephalitis;
- Intracerebral hematomas can lead to encephalopathy;
- Heavy bleeding most often ends in death;
- After a fracture of the base of the skull, paralysis of the entire body may develop;
- Often patients suffer from psychological and emotional disorders, reduce mental abilities.
Rehabilitation after fractures of the skull
With minor injuries, recovery of the patient passes quickly. Rehabilitation is mainly carried out at home and includes rest, walking outdoors, taking nootropics and sedatives, a special diet. Severe injuries rarely do without consequences. Rehabilitation of such patients is lengthy, sometimes takes years. But still, many remain disabled and can not return to their normal life.