Prognosis and Complications of Depressed Skull Fracture.

Lee, Kyeong Seok; Back, Seung Ho; Bae, Hack Gun; Doh, Jae Won; Yun, Il Gyu; Byun, Bak Jang

Original Article

Journal of Korean Neurosurgical Society 1994;23(10): 1143-1149.

Kyeong Seok Lee, Seung Ho Back, Hack Gun Bae, Jae Won Doh, Il Gyu Yun, Bak Jang Byun

Department of Neurosurgery, Soonchunhyang University Chonan Hospital, Chonan, Korea.

ABSTRACT

Complications such as infection, seizure, or intracranial hemorrhage are relatively common after depressed skull fractures. However, indications, methods, and efficacy of the surgical treatment are controversial. This study includes 113 patients with depressed skull fractures who were treated at Soonchunhyang University Chonan Hospital between 1989 and 1992. Methods of treatment, complications, and the prognosis were retrospectively collected and the prognostic factors were analysed. Depressed skull fracture was common below the age of 20 years(38%). Male to female ration was 5.3:1. Traffic injury was the most common of depressed skull fracture(68.1%). Glasgow coma score(GCS) on admission was 13-15 in 52%, 9-12 in 18.6%, and closed in 32%. Intracranial injury was accompanied in 43%. The frontal area was the most common site of depression(53%), and the parietal region was the next(28%). In 65% of open fractures and 28% of closed ones, the lesions were surgically corrected. Cranitomy with primary reconstruction was the most common operative procedure. The mean hospital stay was 26 days in surgically treated patients, and it was 17 days in conservatively managed patients. Prophylactic anticonvulsants were administered in 43%. Seizures occured in 6.2%, and infections were encountered in 3.5%. The outcome was favorable(good recovery and moderate disability) in 80% and the mortality rate was 16%. The outcome was better when the GCS on admission was high(P<0.005), the pupillary response was normal(P<0.005), and the lesion was treated by surgery(P<0.005). Seizures were more common when the GCS was low(P<0.005). Although infections were developed in surgically treated patients only, this difference lacked a statistical significance.

Key Words: Depressed skull fracture; Complication; Methods of treatment; Prognosis; Head injury