Riaz-ur Rehman, Mushtaq, Mian Iftihar-ul Huq, Farooq Azam, Azmatullah Khattak.
Skull Fracture on X-ray skull as an indicator of Extradural Hematoma in patients with Head Injury.
Pak J Surg Jan ;28(2):106-9.

Objectives: To know the co incidence of extradural hematoma in cases of skull fracture on plane x-ray in patients with head injury. Methodology: Th is cross sectional descriptive study was done in neurosurgery department of Hayatabad Medical Complex, Peshawar, from 17th May 2010 to 16th November 2010. All patients of head injury, from all ages and both genders were included. Patients in whom EDH caused by bleeding disorders or vascular malformations of the dura mater and post surgical EDHs were excluded from the study. CT scan brain with bone window was done for all patients to confi rm their diagnosis. Site of hematoma and fracture was documented in patient’s Performa .Exclusion criteria were followed strictly to avoid any bias or confounding in our results. Results: A total of 164 patients were with head injuries were included in the study. Mean age was 27+ 2.7. Th e greatest representation was found in the 21 to 30 years age groups i.e. 42 patients (25.60 %). Male to female ratio was 2.03:1. Th e causes of head injuries were road traffi c accidents i.e. n=85(51.82%). Other causes were fall in 41(25%) patients, physical assaults in 29 patients (17.7%) and 9 patients (5.48%) had other causes of their head injuries. EDH was found only in 14 patients (8.53%).Five patients (35.71%) had their hematomas in temporal region. Temporoparietal region was involved in 4 (28.57%) patients. Frontal and parietal region was aff ected in 2 patients (14.28%) each. One patient had extradural hematoma in posterior cranial fossa. A total of 51(31.09) patients had skull fracture out 164 .Th irty patients (58.82%) had skull fractures at Temporoparietal region. Temporal fracture was present in 8(15.68%) patients. Frontal bone of skull was fractured in 6(11.76%) while parietal bone fracture was noticed in 5(9.80%) patients. Extradural hematoma was found in 14 patients (8.53%). Similarly skull fracture was present in 31.09% (n=51) patients. However when CT scan of patients with extradural hematoma was evaluated, skull fracture was noticed only in 10 (71.42) patients. Conclusion: In majority of extradural hematoma patients there is concomitant skull fracture as well. CT scan brain is the investigation of choice if skull fracture is found on plane skull XRay so that underlying extradural hematoma is ruled out.

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