Mumtaz Ali, Liaqat Ali, Inayat Shah Roghani.
Surgical management of depressed Skull fracture.
J Postgrad Med Inst Jan ;17(1):116-23.

Objectives: To study the outcome of surgical management of depressed skull fracture. Material And Methods: This study was conducted form April 1995 to March 2001, in department of Neurosurgery PGMI/LRH Peshawar. A total of 98 patients with depressed skull fracture, treated surgically were included in the study. It included patients operated for cosmetic reasons or functional outcome. Patients treated conservatively, secondary to fire arm injury and penetrating objects were excluded from the study. Details regarding the causes, duration and clinical conditions were documented. X Rays skull were done in all cases. CT scan was done in 78 cases. After surgery patients were followed up for 9 months. Clinical examination of the wound for sepsis, CSF leak, check up X Rays/CT scan and neurological assessment of patients was done on every visit. Results: A total of 98 patients were operated under general anesthesia in the emergency. There were 63 (61.74%) male and 35 (34.3%) female patients with age ranged from 01-55 years with an average age of 11 years The causes of depressed skull fracture were, falls from height in 53 (51.94%) cases, road traffic accident in 32 (31.36%) cases sports injury in 2 (1.96%) cases, physical violence in 7 (6.86%) cases and miscellaneous in 8 (7.8%) cases. 30 (29.4%) cases were operated for cosmetic purpose while the rest of 68 (66.64%) cases were operated for functional outcome. Closed depressed skull fracture was noted in 23 (22.54%) cases, while compound depressed skull fracture was in 75 (73.5%) cases. The incidence of depressed skull fracture was 14 (13.7%) in frontal bone, 17 (16.66%) in fronto-parietal, 18 (17.64%) in temporal, 30 (29.4%) in parietal, 11 (10.78%) in occipital, 4 (3.9%) on superior saggital sinus, 3(2.94%) on confluence of sinuses and 1 (0.96%) on transverse sinus. Indications for surgery were depressed skull fracture more than 5 mm in frontal, fronto-parietal area, all opened depressed skull fractures, with focal neurological deficit, leaking CSF and oozing brain matter along with depressed fracture. Postoperatively 66 (64.68%) showed excellent recovery, 13 (12.74%) were hamiparetic, 3 (2.94%) were dysphasic, 11(10.78%) were having seizures, 9 with post traumatic syndrome and 2 (1.96%) remained in vegetative state, and 4 (3.92%) developed meningitis. No CSF leaks were noted. Conclusions: In time surgical management gives excellent results and leads to minimize the sequel of this condition. Most of the causes can be prevented just by adopting preventive measures.

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