A pediatric patient may develop a skull fracture after blunt head injury. Early diagnosis is essential for optimum management.


Major descriptors:

(1) bone depressed vs not depressed

(2) closed vs open (compound) fracture


Nondepressed fractures:

(1) linear

(2) stellate (linear with subsidiary fractures)


Depressed fractures:

(1) with disruption of the calvarium

(a) depression less than the thickness of the adjacent bone

(b) depression greater than or equal to the thickness of the adjacent bone (below the inner table)

(2) indentation of the calvarium in an infant without bone disruption ("pond" or "ping-pong ball")


Open or compound fractures carry a significant risk for infection unless the wound is carefully debrided, cleared of foreign bodies and carefully irrigated.


Additional types of fractures:

(1) basal skull fractures

(2) diastatic fracture along a suture line prior to suture closure (around age 4 years)

(3) "growing" skull fracture associated with a poroencephalic or leptomeningeal cyst



(1) intracranial hemorrhage (epidural, subdural, other) with or without laceration of an intracranial artery or sinus

(2) infection

(3) concussion

(4) seizures

(5) brain injury with contusion and/or necrosis

(6) laceration of the dura mater

(7) leakage of cerebrospinal fluid (CSF otorrhea or rhinorrhea) following a basal skull fracture


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