Gas gangrene occurring soon after compound depressed skull fracture

Summary A retrospective evaluation of the prognostic value of different parameters available in patients affected by glial tumours and submitted to serial stereotactic biopsy is presented. The series investigated includes thirty-three untreated patients with proven brain gliomas submitted to stereotactic biopsy. All patients have been clinically and neuroradiologically monitored for three years. The factors investigated belong either to the preoperative data (clinical history and symptomatology, CT pattern and volume of the lesion) or to histological and biological data obtained after the stereotactic biopsy. The results suggest the need of a multimodal prognostic evaluation in glial tumours and particularly stressed is the accuracy of prognostic indications derived from cell kinetic studies.Presented at the European Congress of Neurosurgery, Barcelona, September 1987.     

Infection rate with replacement of bone fragment in compound depressed skull fractures

BACKGROUND: Traditional management of compound depressed skull fractures entails elevation and removal of all bone fragments with delayed cranioplasty. Bone fragment removal is intended to reduce the potential for infection. However, bone fragment removal often necessitates a second operation to repair the resultant calvarial defect. This study examines the postoperative infection rate when bone fragments are replaced primarily. METHODS: A retrospective study was carried out of all patients admitted with the diagnosis of compound depressed skull fracture to a university hospital from 1991 to 1996. RESULTS: Of 52 patients with the diagnosis of compound depressed skull fracture treated at our university hospital over the past 5 years, 32 underwent elevation and repair within 72 hours. All patients except one received antibiotics during surgery and for at least 1.5 days after surgery. Follow-up averaged just over 22 months. In all 32 consecutive patients treated with debridement and elevation of compound depressed skull fractures with primary replacement of bone fragments within 72 hours of injury, there were no infectious sequelae. CONCLUSIONS: Immediate replacement of bone fragments in compound depressed skull fractures does not increase the risk of infectious complications.     

Delayed occurrence of intracranial supratentorial chondroma following compound depressed skull fracture

Summary We describe an exceptional case of a frontal convexity chondroma arising at the site of a compound depressed skull fracture operated on 12 years earlier. We conclude that intracranial chondroma should be included in the differential diagnosis of a calcified mass for the patients who had had a compound, depressed skull fracture along the suture line, especially in cases of dural laceration by the fragmented bone.     

Management of depressed skull fracture in the newborn.

The authors describe 3 cases of neonatal depressed skull fracture subsequent to difficult delivery, treated without surgical elevation. None of the patients developed neurological deficits, cosmetic deformity or electroencephalographic signs of epileptiform activity. Neonatal depressed skull fractures not associated with focal neurological signs may not require surgical therapy; we are not certain what the absolute criteria for operation should be.     

Phaeohyphomycosis complicating compound skull fracture

Intracranial infection is a well-recognized complication of compound skull fractures. In most cases various bacteria are identified as the etiologic agents. Fungal infection complicating open head trauma is unusual. We describe a patient who contracted fatal meningoencephalitis due to Drechslera spicifera, a rarely pathogenic soil saprophyte, after open head trauma.     

Clinical and experimental morphological study of depressed skull fracture

Ninety-eight cases of depressed skull fractures, caused by various accidents, were treated. The morphological structures of the fractures were studied. Thirty-four depressed fractures were established experimentally, and a comparable study was performed. Clinically and experimentally I confirmed the same morphological reactions, that is, that the fractures of the inner region were always larger than those of the outer side, as a result of the direction of the impacting forces. The human skull suffers depressed fractures only because it has "HSH" (hard-soft-hard) histological structures. It is naturally disadvantaged.     

Outcome of primary bone fragment replacement in compound depressed skull fractures

Objective: To assess the outcome in terms of infectious complications after primary bone fragment replacement in compound depressed skull fractures, regardless of the degree of wound contamination. Design: Case series. Place and Duration of Study: Combined Military Hospital, Rawalpindi, from August 2005 to October 2006. Patients and Methods: Patients of all ages and both genders with compound depressed skull fractures irrespective of the degree of wound contamination were selected. Patients with already infected skull wounds were excluded. Bone fragments were replaced in all cases. Main outcome variables were age, associated CT scan findings, type of fracture, location of fracture, wound type, admission to operation time, interval and infectious complications after surgery. Results: Of the 51 cases, the wounds were classified as clean in only 9 patients and the rest had variable degrees of contamination. Thirty five patients were operated within 24 hours, 13 were debrided and bone fragments replaced within 24-72 hours and 3 patients were treated after 72 hours. Thirty five patients were earthquake victims. The average age of the patients was 28.6 years. Three patients developed wound infection and osteomyelitis. One patient had free-floating bone fragments due to the development of hydrocephalus with no evidence of infection. Conclusion: Bone fragment removal in compound depressed skull fractures, regardless of the degree of wound contamination, is not obligatory and primary bone fragment replacement is a suitable alternative, which also avoids a second cranioplasty.     

Injury to the longitudinal sinus accompanying a depressed fracture of the skull

A case of trauma to the longitudinal sinus following a depressed fracture of the vault of the skull with recovery is reported.     

An unusual management of an open compound depressed skull fracture with venous sinus involvement. A case report

A neurosurgical management of an open compound depressed fracture perforating the superior sagittal sinus is reported. Undue bleeding from the fracture did not allow a conservative management. The patient had been operated primarily at an outside emergency surgery unit. Profuse uncontrollable bleeding made a tamponade of the sinus necessary for transportation to our neurosurgical department. After reconstruction of the sinus he survived without evidence of a neurological deficit.     

An unusual cause of depressed skull fracture: case report

BACKGROUND: Camel collision accidents are a common occurrence in Saudi Arabia, with a high rate of mortality and morbidity. Isolated injuries are rare because of the nature of impact sustained by the person. CASE DESCRIPTION: A 4-year-old child with an isolated depressed skull fracture resulting from a camel collision is described. The other occupants of the car were crushed to death. The child sustained only an impact to his head, causing a compound depressed skull fracture with localized cortical damage. CONCLUSIONS: Camel collision accidents are a common cause of mortality and morbidity in Saudi Arabia. Isolated skull injuries are rare and result from a localized impact. This is the first report of a compound depressed skull fracture from such an incident. The extent of the problem and efforts toward prevention are described.     

Superior sagittal sinus occlusion caused by a compound depressed skull fracture: a case treated by emergency surgery

Depressed skull fractures compressing major venous sinuses are rare, and the treatment is a matter of controversy. The majority of depressed fractures are treated conservatively for fear of bleeding from venous sinuses, but surgical intervention was conducted in a few cases. We report a case of a 59-year-old man with a compound depressed fracture occluding the superior sagittal sinus (SSS). The patient was struck on the head by a heavy iron bar and admitted to our emergency center because of deterioration of consciousness. A computed tomographic scan showed depressed skull fracture overlying the SSS with hemorrhagic lesions in the bilateral parietal lobes and an acute epidural hematoma at the right temporoparietal convexity. Digital subtraction angiography (DSA) showed an occlusion of the SSS and compensatory venous drainage associated with poor capillary filling in the left parietal lobe. On an emergency basis, bone fragments compressing the SSS were surgically removed piece-by-piece to resolve severe venous congestion and to avoid infection. A small tear in the SSS was treated by head elevation and compressing the SSS with Gelfoam. Postoperative DSA confirmed the patency of the SSS and normal blood flow in the left parietal lobe. The patient exhibited slight disorientation and was transferred to another hospital for further rehabilitation. Because of symptomatic severe venous congestion, we had to perform emergency surgical decompression and removal of bone fragments. Treatment strategy for depressed skull fracture with SSS involvement was discussed with review of the literature.     

Compound depressed skull fracture caused by a flying model helicopter

Compound depressed skull fractures are usually caused by high‐energy direct blows with sharp or blunt objects. A clear mechanism of injury is crucial in evaluating the degree of damage and formulating a management plan. We report an unusual cause of such a condition in this study. The patient, a 45‐year‐old male, suffered from head injury by a flying model helicopter. The flying of model helicopters is forbidden in the area where the incident occurred. He was confused on site and was found to be hemiplegic. Emergency wound debridement, craniectomy and external ventricular catheterization were done. Six months after the operation, the patient could walk with the assistance of a stick and cranioplasty has been planned for him. The potential dangers of flying model helicopters are well presented in this study. The authors strongly recommend implementation of safety measures to minimize the potential risk of the game or other similar games.     

Spontaneous reduction of a closed depressed skull fracture: a case report

Presented is a single case of a 6-year-old child in whom a closed depressed skull fracture was found to be elevated spontaneously less than 2 days after the injury. There were no cosmetic or neurological sequelae at follow-up. This case demonstrates that these injuries do not always require operation and that they occasionally resolve spontaneously, even in school-age children.     

Spontaneous elevation of a depressed skull fracture in an infant. Case report.

This is a report of an infant with a depressed skull fracture that apparently elevated spontaneously within a period of 4 hours.