Infection rate with replacement of bone fragment in compound depressed skull fractures

BACKGROUND Traditional management of compound depressed skull fractures entails elevat ion and removal of all bone fragments with delayed cranioplasty. Bone fragm ent removal is intended to reduce the potential for infection. However, bon e fragment removal often necessitates a second operation to repair the resu ltant calvarial defect. This study examines the postoperative infection rat e when bone fragments are replaced primarily. METHODS A retrospective study was tarried out of all patients admitted with the dia gnosis of compound depressed skull fracture to a university hospital from 1 991 to 1996. RESULTS Of 52 patients with the diagnosis of compound depressed skull fracture trea ted at our university hospital over the past 5 years, 32 underwent elevatio n and repair within 72 hours. All patients except one received antibiotics during surgery and for at least 1.5 days after surgery. Follow-up averaged just over 22 months. In all 32 consecutive patients treated with debridemen t and elevation of tom pound depressed skull fractures with primary replace ment of bone fragments within 72 hours of injury, there were no infectious sequelae. CONCLUSIONS Immediate replacement of bone fragments in compound depressed skull fractur es does not increase the risk of infectious complications. (C) 1999 by Else vier Science Inc.