Skull fractures in adults
- William G Heegaard, MD, MPH
William G Heegaard, MD, MPH
- Professor of Emergency Medicine
- University of Minnesota School of Medicine
- Michelle H Biros, MD
Michelle H Biros, MD
- Professor of Emergency Medicine
- University of Minnesota Medical School
- Section Editor
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Skull fractures have plagued humankind throughout history . They occur when forces striking the head exceed the mechanical integrity of the calvarium. Significant skull fractures are often accompanied by moderate or severe intracranial injury and extracranial injuries associated with high-energy trauma, such as cervical and other spine fractures and thoracoabdominal injuries [2-9].
The epidemiology, mechanisms, clinical presentation, associated complications, and initial management of skull fractures in adults are reviewed here. Skull fractures in children and intracranial injuries are discussed separately. (See "Skull fractures in children: Clinical manifestations, diagnosis, and management" and "Intracranial epidural hematoma in adults" and "Subdural hematoma in adults: Etiology, clinical features, and diagnosis" and "Nonaneurysmal subarachnoid hemorrhage" and "Concussion and mild traumatic brain injury".)
The incidence of skull fractures among head injured adults who present to emergency departments (ED) is unknown. The parietal bone is most frequently fractured, followed by the temporal, occipital, and frontal bones . Linear fractures are the most common, followed by depressed and basilar skull fractures. (See 'Definition and presentation of skull fracture types' below.)
Much of the data on skull fractures in adults come from studies of traumatic brain injury (TBI). Each year, approximately 2.8 million people sustain head injuries in the United States alone, resulting in 2.5 million undergoing emergency evaluation .
According to one retrospective study of 207 head-injured patients, 37 percent of those with associated intracranial pathology sustained a linear skull fracture . According to another retrospective study of 2254 cases of head trauma from assault, approximately one-third sustained a skull fracture .
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- ANATOMY AND MECHANISM OF INJURY
- PREHOSPITAL MANAGEMENT
- INITIAL EVALUATION
- DIAGNOSTIC IMAGING
- DEFINITION AND PRESENTATION OF SKULL FRACTURE TYPES
- Linear skull fracture
- Depressed skull fracture
- Basilar skull fracture
- Penetrating skull fracture
- MANAGEMENT OF SPECIFIC INJURIES
- Linear fractures
- Depressed fractures
- Basilar fractures
- Anticoagulated patients
- Penetrating injuries
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS