Patient selection: 0 to 16 years of age
Types of depressed skull fractures:
(1) true (usually V-shaped)
(2) flat
(3) ping-pong ball
Risk factors for a worse outcome following head injury with depressed skull fracture:
(1) compound fracture
(2) flat fracture
(3) depression > 1 cm
(4) intracranial complication(s) (dural tear, cortical laceration, hematoma, other)
(5) unilateral pupillary dilatation
(6) admission Glasgow coma score (GCS) <= 8
(7) penetrating injuries, including gunshot wounds
(8) loss of consciousness at the time of injury
Low risk patient who can be managed conservatively:
(1) simple fracture
(2) depression <= 1.0 cm (the less the better)
(3) absence of intracranial complications
A low risk patient with a ping-pong ball fracture had the best outcome.
