Ersahin et al identified risk factors associated with complications in pediatric patients with depressed skull fractures. This can help identify high risk patients who may benefit from more aggressive management. The authors are from Ege University in Izmir, Turkey.


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.


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