Ishman and Friedland developed an anatomic classification for temporal bone fractures that correlates with clinical complications. The authors are from the Medical College of Wisconsin.

Fracture Type



involves petrous apex and/or otic capsule


any other


Subtypes of nonpetrous fracture:

(1) middle ear

(2) mastoid (which may include the medial mastoid air cells of the petrous bone)


Petrous fractures are associated with the more serious complications (CSF leak, inner ear injury, facial nerve damage, and carotid artery injury).


Nonpetrous fractures through the middle ear are associated with conductive hearing loss (with disruption of the ossicular chain). Nonpetrous fractures involving the mastoid are associated with a low incidence of serious complications.


To read more or access our algorithms and calculators, please log in or register.