The management of depressed skull fractures in children at Muhimbili Medical Centre, Dar es Salaam, Tanzania.

Thirty eight consecutive children with depressed fracture of the skull admitted to the Paediatric Surgical Unit (PSU) of Muhimbili Medical Centre (MMC), Dar es Salaam between January 1986 to May 1992 were studied. There were 22 boys and 16 girls. Age range was from birth to 10 years. A fall of one form or another accounted for 25 (65.00%) patients. Falling from a sister's or mother's back occurred in 4 (10.5%) patients, while falling from trees was a cause in 8 (21%) patients. Objects hitting on the head accounted for 6 (15.8%) patients. The objects included stones in 3 and falling coconut fruits in three. Traffic motor accidents accounted for 5 (13.2%) patients. In 35 (92.1%) patients, the fractures were closed while in 3 (7.9%) they were open. The fractures were located in the frontal or parietal bone in 27 (76.3%) patients. The 3 coconut fractures were located at the sagittal area. Only 4 (10.5%) patients had focal neurological signs. Convulsions were recorded in 3 patients while loss of consciousness was observed in 4 patients. Surgery was performed on 22 (57.9%) patients while conservative approach was practised in 16 (42.1%). The indications for surgery were cosmetics in 15 patients, compound fracture in 3 patients, focal neurological deficit in 2 patients, and torn dura presenting with Pseudo-meningocele in 2 patients.