#Baby skull fracture series

In our series of 100 patients, skull fracture was present in 47% of the patients with 21% having underlying brain lesion. Galbraith noted that skull fractures are often unsuspected on clinlical grounds, but are associated with a greatly increased risk of intracranial haematoma and he reasoned that X-ray skull films are helpful in identifying this group of patients. Therefore, it becomes important to identify these fractures and admit the patient when a fracture is present. Jennett has stated that when complications occur after apparently mild injury, there is usually a skull fracture. However, other authors are equally convinced that emergency X-ray skull films are a useful adjunct in the management of the head injured patients. similar conclusions were reached by Balasubramanium et al in a review of over 2000 patients. Eyes and Evans in a review of over 500 patients who underwent skull X-ray concluded that there was no correlation between radiographic findings and need for hospital admission. The usefulness of skull X rays in the initial evaluation of patients with head injury was always controversial. However, lateralising signs were not present at the time of admission in any of the case. At times the child was brought in a convulsive or post convulsive state which was controlled by IV phenytoin sodium and at times IV diazepam. The commonest presentation was a history of transient loss of consciousness with vomiting and drowsiness. Similar mode of injury was reported in different series from this country. In our set up and in the present series, the commonest cause of head injury was due to a fall (88%) from a window, balcony or unguarded roof of a house or due to tumble down the stairway. We have not encountered the problem of a “battered child” which has acquired a sinister proportion in the developed countries. These injuries are more severe, which perhaps explains the high incidence of skull fracture and intracranial haematoma reported in their literature. Inflicted injuries account for nearly 25% of children for head injuries in developed countries. Most injuries occurred in children living in traditional old houses of Jaipur city having low parapet which is responsible for high percentage of fall while playing or flying kite. Head injuries in children are common but they are almost always benign in their course. Maximum number of patients were hospitalized for 48 hours. The minimum hospital stay was 24 hours and longest hospital stay was 3 weeks. Two patients died, one because of severe primary diffuse axonal injury and other as a result of associated multiple injuries of chest and abdomen. Only 7 patients were transferred to neurosurgical department where 3 were operated for haematoma and 4 treated conservatively. The intracranial lesion occurred more frequently in children with a skull fracture (in 21 cases out of 47) than in those without one (in 12 cases out of 53).

$baby skull fracture$

Tenty one cases who had fracture skull also had contusion/haematoma and cerebral edema on CT scan. All cases were subjected to CT scan brain, which revealed positive scans in 33 cases, out of which 15 cases were of cerebral edema ( Table-3). Skull X-ray was carried out in each case and 47% of cases showed linear fractures (26 parietal, 15 frontal and 3 each in temporal and occipital regions). Evaluation of patients as per Glasgow Coma Scale (GCS) at admission revealed that 70% of patients had minor injury (GCS-15/15) ( Table-2). Vomiting and loss of consciousness were the main presenting symptoms followed by convulsions and bleeding from mouth, nose or ear. The seventy five percent cases occurred in summer holidays and kite flying season. Seventy percent of falls occurred in early evening when children were playing unattended. 10 feet (88%) followed by pedestrian/road traffic accidents ( Table 1). The most common cause of injury was a fall from height of approx. Skull fractures were found in 30 out of 68 males and in 17 out of 32 females. There was a striking rise in incidence at the age of 5 years but beyond 5 years the numbers tended to fall. Twenty four percent of injuries occurred in infants below the age of 2 years. There were 68 males and 32 females in the age range of 8 months to 11 years.

$baby skull fracture$

The 100 pediatric patients of head injury were evaluated for age, sex, nature of injury, presenting symptoms, GCS and CT scan findings.

$baby skull fracture$