Skull fracture (peds)

Background

• Predictor of intracranial injury
• Infants are at higher risk due to thinner calvarium
• Most skull fractures have overlying hematoma

Clinical Features

• Scalp hematoma
• Skull tenderness
• Skull depression or crepitus
• Battle sign or raccoon eyes (basal skull fracture)

Differential Diagnosis

Head trauma

• Traumatic brain injury
  • Intracranial hemorrhage
    • Intra-axial
      • Traumatic intracerebral hemorrhage
    • Extra-axial
      • Epidural hemorrhage
      • Subdural hemorrhage
      • Subarachnoid hemorrhage
  • Moderate-to-severe traumatic brain injury
    • Elevated intracranial pressure
  • Mild traumatic brain injury
    • Clinical decision rules for head CT in trauma
    • Post-concussive syndrome
• Orbital trauma
• Maxillofacial trauma
• Scalp laceration
• Skull fracture
  • Basilar skull fracture
  • Skull fracture (peds)
• Pediatric head trauma
  • PECARN head trauma rule

Maxillofacial Trauma

• Ears
  • Auricular hematoma
• Nose
  • Nasal fracture
  • Nasal septal hematoma
• Oral
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

Evaluation

• Head CT

Management

• Consider antibiotics for:
  • Open fracture
  • Depressed fracture
  • Sinus involvement
  • Pneumocephalus
• Ceftriaxone AND metronidazole +/- vancomycin

Disposition

• Consider discharge if:
  • Neurologically normal
  • Isolated closed linear skull fracture
  • No concern for non-accidental trauma
• Admit all others

See Also

• Head Trauma
• Skull fracture (Adult)