HEAD INJURY, SKULL FRACTURE |
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General Information
DEFINITION--Skull fractures may be of two types:
A closed, or simple, break in the bone without breaking the skin or bone covering (periosteum).
An open, or compound, break that breaks the skin and periosteum.
BODY PARTS INVOLVED
Skull.
Periosteum (fibrous covering of bone).
Soft tissue adjacent to the skull, including skin and underlying tissue, muscles, nerves and tendons.
Brain (sometimes), if bone fragments are depressed into the brain.
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SIGNS & SYMPTOMS
Pain and swelling over the skull fracture.
Bruising over the fracture and around the eyes and nose.
Profuse bleeding from the scalp if the skin is broken.
Leakage of clear fluid (cerebrospinal fluid) into the ear or nose.
ADDITIONAL SIGNS, IF BRAIN DAMAGE ACCOMPANIES THE SKULL FRACTURE:
Drowsiness or confusion.
Vomiting and nausea.
Blurred vision.
Loss of consciousness--either temporarily or for long periods.
Amnesia or memory lapses.
Irritability.
Headache.
CAUSESDirect blow to the head.
RISK INCREASES WITH
Contact sports, especially if the head is not protected adequately.
Sports that involve heavy equipment such as baseball bats or golf clubs.
Sports such as basketball, gymnastics, diving or cycling, in which falling on the head is possible.
Poor nutrition, especially calcium deficiency.
HOW TO PREVENTWear a protective helmet or other appropriate headgear during athletic activity in which head injury is possible.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's diagnosis and care.
Hospitalization (serious skull fractures).
Home care if hospitalization is not necessary.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor. Total extent of the injury may not be apparent for 48 to 72 hours following injury.
X-rays of the head and neck to assess total injury to soft tissue.
CAT scan (See Glossary) of the head.
Laboratory studies of blood and cerebrospinal fluid.
POSSIBLE COMPLICATIONS
Hematoma (a collection of blood) that creates pressure on the brain. This can cause permanent brain damage or death, depending on the extent of injury.
Prolonged healing time if activity is resumed too soon.
Infection if skin over the skull fracture is broken.
PROBABLE OUTCOMEMost skull fractures without complications heal within 4 to 6 weeks. Prompt medical evaluation and treatment are essential to prevent or treat complications. These can be life-threatening or cause permanent brain damage.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. This is critical to minimize bleeding and swelling. See Appendix 1 for details.
CONTINUING CARE
The extent of injury can be determined only with careful examination and observation. After a doctor's examination, the injured person may be sent home -- but a responsible person must stay with the person and watch for serious symptoms. The first 24 hours after injury are critical, although serious aftereffects can appear later. If you are watching the patient, awaken him or her every hour for 24 hours. Report to the doctor immediately if you can't awaken or arouse the person. Report also any of the following:
Vomiting.
Inability to move arms and legs equally well on both sides.
Temperature above 100F (37.8C).
Stiff neck.
Pupils of unequal size or shape.
Convulsions.
Noticeable restlessness.
Severe headache that persists longer than 4 hours after injury.
Confusion.
MEDICATION
Don't give ANY medicine--including non-prescription acetaminophen or aspirin -- until the extent of injury is certain.
ACTIVITY
The patient should rest in bed until the doctor determines that the danger of complications--especially hematomas -- is over. Normal activity may then be resumed as symptoms improve.
DIETFollow a full liquid diet for 24 to 48 hours until the danger of complications passes.
REHABILITATIONDepends on whether brain damage occurs. Consult your doctor.
CALL YOUR DOCTOR IF
You have signs and symptoms of a skull fracture after a blow to the head, or you observe signs of a head injury in someone else.
After returning home, any signs or symptoms appear that are listed under Continuing Care.
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