Compound elevated skull fractures: Review of literature.

INTRODUCTION

Compound elevated skull fractures (CESF) are rare traumatic injuries. To date, only 27 cases have been reported.

METHODS

The authors report three cases of CESF managed at their institute. All were middle-aged males. The mechanism was assault by sharp-edged objects in two and road traffic accident (RTA) in one case. One underwent simple suturing; debridement and decompressive craniectomy was done in the remaining two cases. Good and poor outcomes were noted in one case each, while one died. A literature review was performed to analyse all cases of CESF reported in English literature.

RESULTS

Including this one, a total of 30 cases were analysed. Mean age was 25.2 years, of which seven were aged < 18 years. There were 12 mild, five moderate, 11 severe HI cases and two cases were not detailed. Underlying injuries were seen in ~ 2/3 of cases. All, except two cases, underwent definitive surgery in the form of debridement with/without haematoma removal. Good-to-excellent outcomes were noted in 2/3 cases. There were 6/30 (20%) deaths noted. CNS infections and poor admission GCS were associated with increased mortality rates.

CONCLUSIONS

CESF are rare injuries. Early surgery in the form of debridement with broad-spectrum antibiotic coverage is recommended to prevent infectious complications and improve outcome. Outcome is dependent on three main factors-admission GCS score, intactness of duramater and post-operative CNS infections.