GROWING SKULL FRACTURES - STRATEGIES FOR REPAIR AND RECONSTRUCTION

Most skull fractures in growing children heal rapidly and without sign ificant contour irregularity. Skull fractures in infants associated wi th dural injuries, however, may progressively enlarge as a result of b one erosion by leptomeningeal herniation at the dural tear sites and a re known as ''growing skull fractures.'' Over a 6-year period, seven g rowing skull fractures occurred in a population of 592 consecutive ped iatric head injuries at Cardinal Glennon Children's Hospital (prevalen ce, 1.2%). Prompt recognition of growing skull fractures, repair by re gional craniectomy and pericranial dural inlay graft, and immediate co ntour reconstruction with rigidly fixed cranial bone graft ensure reli able aesthetic and functional restoration of the growing neurocranium.