In order to assess the predictive value of certain biomechanical param
eters for skull fracture after head injury, a prospective analysis was
undertaken of a series of 5416 head-injured patients. In each case an
assessment was made at presentation as to the velocity of impact and
the physical properties of the impacting agent. The incidence of skull
vault fracture was then calculated for injuries sustained at differen
t velocities and for different types of contact. The incidence of frac
ture was also calculated with respect to the presence of post-traumati
c amnesia (PTA). The incidences (95 per cent confidence intervals) of
skull fracture at low, medium and high speeds were 0. 1 7 (0.042 7-0.4
33), 1.99 (1.47-2.63) and 10.2 (7.41-12.6) per cent respectively. Frac
tures tended to occur with greater frequency after impacts against bro
ad hard surfaces or small objects rather than against broad soft objec
ts. The percentage incidence of fracture in adults suffering more than
5 min of PTA was 17.93 (12.4-23.5) compared with 0.6 74 (0.3 72-1. 1)
in those without amnesia. Patient selection for skull radiography aft
er an apparently minor head injury can be guided by an assessment of p
ost-traumatic amnesia and the biomechanics of the injury.