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Sat Aug 23 00:08:01 BST 2003

Depressed fractures are a problem.  History of impact against a projection
helps diagnosis.  There may well be no alteration of consciousness as the
local fragmentation of the skull has absorbed the impact energy (compare
"crumple zone" in cars).  There is often a scalp laceration and the
depression may be felt while this is being cleaned and closed but is often
missed.

Our new UK guidelines call for CT if there is suspicion of open or depressed
fracture, but you have got to suspect it in the first place.

By no means all depressed fractures need surgery but missing the open skull
injury can be important.  It's scalp lacerations with history of local
impact rather than haematomas that may need imaging.

Jonathan Marrow

----- Original Message ----- 
From: "Bjorn, Pret" <pbjorn at emh.org>
To: "'Trauma & Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Friday, August 22, 2003 3:53 PM
Subject: RE: x-ray work up for blunt head injury - selective use of
SXRsaspotential pre-discharge filter from the ED

> Thanks.  But does this or any similar anecdote suggest that all patients
> with scalp hematomas (hematomae?) need a screening x-ray?  That's a big
pile
> of negative films, isn't it?
>
> Wouldn't it be more appropriate--perhaps cheaper as well--to have the
> patient re-examined in a few days, or in the event of symptoms?
>
> In the absence of discernable brain injury, given appropriate patient
> instructions and follow up, what are the clinical ramifications of delayed
> diagnosis of skull fracture?
>
> Pret
>
> -----Original Message-----
> From: Richard Wigle MD FACS [mailto:rlwigle at yahoo.com]
> Sent: Friday, August 22, 2003 10:34 AM
> To: Trauma & Critical Care mailing list
> Subject: RE: x-ray work up for blunt head injury - selective use of
> SXRsas potential pre-discharge filter from the ED
>
>
> I have seen at least one case of depressed skull fracture
> where the depression exceeded the width of the tables but
> the patient was clinically normal and the skull could not
> be palpated due to a hematoma, the diagnosis was made by a
> tangential skull film
>
> I am however not sure of the long term course since it
> passed out of my hands
>
>
> --
> trauma-list : TRAUMA.ORG
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>

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Imaging and possible depressed fracture