Surgical management of depressed cranial fractures.
METHODS
Patients with open (compound) cranial fractures depressed greater than the thickness of the cranium should undergo operative intervention to prevent infection. Patients with open (compound) depressed cranial fractures may be treated nonoperatively if there is no clinical or radiographic evidence of dural penetration, significant intracranial hematoma, depression greater than 1 cm, frontal sinus involvement, gross cosmetic deformity, wound infection, pneumocephalus, or gross wound contamination. Nonoperative management of closed (simple) depressed cranial fractures is a treatment option.


METHODS
Early operation is recommended to reduce the incidence of infection.


METHODS
Elevation and debridement is recommended as the surgical method of choice. Primary bone fragment replacement is a surgical option in the absence of wound infection at the time of surgery. All management strategies for open (compound) depressed fractures should include antibiotics.
Department of Neurological Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
M Ross
MR
Bullock
Randall
R
Chesnut
Jamshid
J
Ghajar
David
D
Gordon
Roger
R
Hartl
David W
DW
Newell
Franco
F
Servadei
Beverly C
BC
Walters
Jack
J
Wilberger
D019468:Disease Management; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*; D012887:Skull Fractures / Q000473:pathology / Q000601:surgery*