A fracture of one or more of the cranial vault bones (frontal, parietal, temporal, sphenoid, and occipital bones).Temporal bone fractures (longitudinal or transverse fractures).Fractures involving the anterior, middle, and posterior cranial fossae.Most commonly seen in newborns and infants.A fracture along the skull suture lines.Open skull fracture: a fracture that is associated with a dural tear that results in communication between the CNS and with the outer environment, either through the skin, sinuses, or ears.The parietal and frontoparietal regions are the most common sites.Soft tissue involvement: compound fracture more common than closed fracture.Number of fracture lines: typically a comminuted fracture.Typically occurs secondary to a high-energy blunt force injury to a small area of the skull (e.g., impact with a baseball bat).A skull fracture in which the skull depresses inward toward the brain parenchyma.Location: Most commonly involves the temporal, parietal, frontal, or occipital bones.Soft tissue involvement: closed fracture or compound fracture possible.Number of fracture lines: simple or comminuted fracture possible.Typically occurs as a result of low-energy blunt trauma to a large surface of the skull (e.g., fall).A single fracture that extends through the entire width of one or more skull bones.
All skull fractures can be subclassified further based on the number of fracture lines (simple or comminuted fractures), the degree of displacement (nondisplaced or depressed fractures), and the involvement of soft tissue (open or closed fractures). Midfacial bone fractures and basilar skull fractures can be simple (i.e., involving a single bone, e.g., nasal bone fractures, temporal bone fractures, zygomatic arch fractures) or complex (i.e., involving more than one bone, e.g., Le Fort fractures of the midfacial bones or zygomaticomaxillary complex fractures). Cranial vault fractures may involve the frontal, parietal, temporal, sphenoid, and occipital bones. Fractures of the skull base are classified according to the affected region ( anterior, middle, posterior cranial fossae). Skull fractures are classified according to the anatomic location of the fracture as basilar skull fractures, cranial vault fractures, mandibular fractures, and midfacial fractures. No deaths occurred, and no inpatient neurosurgical procedures were performed.Skull bone fractures most typically occur due to blunt force trauma from contact sports, motor vehicle collisions, or falls. Admission rate significantly decreased (52% to 38%, p = 0.04), and the 72-hour emergency department revisit rate trended down but was not statistically significant (2.8/year to 1/year, p = 0.2). Trauma consultations and consultations for abusive head trauma did not significantly change (p = 0.2 and p = 0.1, respectively). The neurosurgery department was consulted for 86% and 44% of preprotocol and postprotocol cases, respectively (p < 0.001). After protocol implementation, there was a relative increase in patients who fell from a height > 3 feet (10% to 29%, p < 0.001) and those with no reported injury mechanism (12% to 16%, p < 0.001). Falls were the most common mechanism of injury (193 patients ). The cohorts did not differ significantly in terms of sex (p = 0.1) or age (p = 0.8). Overall, 57% were male, and the median (interquartile range) age was 9.1 (4.8–25.0) months. The preprotocol and postprotocol cohorts included 162 and 82 children, respectively.
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