Repair of compound-depressed skull fractures in children with replacement of bone fragments

A retrospective study of 31 consecutive cases of compound-depressed skull fractures treated by bone fragment replacement between October 1983 and August 1990 was performed. Epidemiology, clinical features, therapy, and outcome were examined and compared with previous series. A protocol is presented for bone fragment treatment intraoperatively and use of intravenous antibiotics (nafcillin and Claforan) perioperatively, despite the degree of wound contamination or dural violation. Of the 31 cases, 15 had dural lacerations with 4 of these requiring patching with pericranium. The degree of wound contamination varied, with only 8 cases considered clean. The average age of patients treated was 8.6 years. At follow-up (average of 26.5 months), all patients had solid bone fusions and well-healed wounds. There were no instances of wound infection or osteomyelitis. No patient required subsequent cranioplasty. It is proposed that bone fragment removal for compound-depressed skull fractures, regardless of the degree of contamination, the presence of dural laceration, or the degree of intracerebral injury, is not necessary and that bone fragment replacement avoids a second operation for cranioplasty.