PEDIATRIC DEPRESSED SKULL FRACTURES - ANALYSIS OF 530 CASES

Depressed skull fractures (DSFs) account for 7-10% of children admitte d to hospital with a head injury and 15-25% of children with skull fra ctures. We reviewed the records of 530 patients operated on for DSF fr om January 1, 1973, to December 31, 1993. This group was made up of 35 7 boys (67%) and 173 girls (33%) whose ages ranged from 1 day to 16 ye ars (mean age 6.1 years). Fall was the most common cause of injury. Of the 530 patients with DSF, 66% had compound fractures. The incidence of compound fractures increased with age. Compound fractures caused mo re brain lacerations (29%) than simple fractures (15.5%) did, We also classified DSFs radiologically as true, flat, or ping-pong ball fractu res. Associated intracranial lesions were found to be a bad prognostic factor. There were 13 deaths (2.5%) in this series. Satisfactory resu lts were achieved in over 95% of the patients. Compound fractures are associated with a worse outcome and a higher incidence of intracranial lesions and cortical laceration. Unilateral pupillary dilatation and an admission GCS score of 8 or less are ominous signs in regard to mor tality. We also found that the deeper the depressed bone, the higher t he risk of both dural tear and cortical laceration and the worse the p rognosis. A conservative approach should be followed in cases of simpl e DSF without associated intracranial hematoma and in cases in which t he bone depression is not deeper than 1 cm.