Diferencia entre revisiones de «Skull fracture (peds)»

Revisión actual - 17:14 17 ene 2026

This page is for pediatric patients. For adult patients, see: skull fracture

Background

Bones of the cranium.

Predictor of intracranial injury
Infants are at higher risk due to thinner calvarium (median age for isolated skull fracture is 10 months)^[1]
Most skull fractures have overlying hematoma

Clinical Features

Scalp hematoma
Skull tenderness
Skull depression or crepitus
Battle sign or raccoon eyes (basilar skull fracture)
Loss of consciousness, nausea/vomiting, altered mental status (less common in younger children than other children and adults with isolated skull fracture)^[1]

Differential Diagnosis

Head trauma

Maxillofacial Trauma

Ears
- Auricular hematoma
Nose
- Nasal fracture
- Nasal septal hematoma
Oral
Other face
- Le Fort fractures
- Mandible fracture
Zygomatic arch fracture
Zygomaticomaxillary (tripod) fracture
Related

Evaluation

Head CT
Evaluate for additional injuries

Management

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

Disposition

Consider discharge if^[2]^[1]:
- Neurologically normal
- Isolated closed linear skull fracture
- No concern for non-accidental trauma
Admit all others

External Links

References

↑ ^1.0 ^1.1 ^1.2 Elizabeth C. Powell, et al. Isolated Linear Skull Fractures in Children With Blunt Head Trauma. Pediatrics Apr 2015, 135 (4) e851-e857; DOI: 10.1542/peds.2014-2858
↑ Bressan, S., Marchetto, L., Lyons, T. W., Monuteaux, M. C., Freedman, S. B., Da Dalt, L., & Nigrovic, L. E. (2018). A Systematic Review and Meta-Analysis of the Management and Outcomes of Isolated Skull Fractures in Children. Annals of Emergency Medicine, 71(6), 714–724.e2.

Authors:

[Powell-1] 1.0 ^1.1 ^1.2 Elizabeth C. Powell, et al. Isolated Linear Skull Fractures in Children With Blunt Head Trauma. Pediatrics Apr 2015, 135 (4) e851-e857; DOI: 10.1542/peds.2014-2858

[2] Bressan, S., Marchetto, L., Lyons, T. W., Monuteaux, M. C., Freedman, S. B., Da Dalt, L., & Nigrovic, L. E. (2018). A Systematic Review and Meta-Analysis of the Management and Outcomes of Isolated Skull Fractures in Children. Annals of Emergency Medicine, 71(6), 714–724.e2.

[1]

[2]

@@ Línea 1: / Línea 1: @@
+{{PediatricPage|skull fracture}}
+==Background==
+[[File:Cranial bones en.png|thumb|Bones of the cranium.]]
+*Predictor of intracranial injury
+*Infants are at higher risk due to thinner calvarium (median age for isolated skull fracture is 10 months)<ref name="Powell">Elizabeth C. Powell, et al. Isolated Linear Skull Fractures in Children With Blunt Head Trauma. Pediatrics Apr 2015, 135 (4) e851-e857; DOI: 10.1542/peds.2014-2858</ref>
+*Most skull fractures have overlying hematoma
-SKULL FRACTURES
+==Clinical Features==
+*Scalp hematoma
+*Skull tenderness
+*Skull depression or crepitus
+*Battle sign or raccoon eyes ([[basilar skull fracture]])
+*Loss of consciousness, [[nausea and vomiting (peds)|nausea/vomiting]], [[altered mental status (peds)|altered mental status]] (less common in younger children than other children and adults with isolated skull fracture)<ref name="Powell" />
--    fxs are predictors of intracranial inj
+==Differential Diagnosis==
+{{Head trauma DDX}}
+{{Maxillofacial trauma DDX}}
--    fx can lead to complications
+==Evaluation==
+*[[Head CT]]
+*Evaluate for additional injuries
--    infants higher risk for fx since
+==Management==
+*Consider antibiotics for:
+**Open fracture
+**Depressed fracture
+**Sinus involvement
+**Pneumocephalus
+*[[Ceftriaxone]] '''AND''' [[metronidazole]] +/- [[vancomycin]]
-o    thinner bones- fx parietal first, then occ, frontal, temp
+==Disposition==
+*Consider discharge if<ref>Bressan, S., Marchetto, L., Lyons, T. W., Monuteaux, M. C., Freedman, S. B., Da Dalt, L., & Nigrovic, L. E. (2018). A Systematic Review and Meta-Analysis of the Management and Outcomes of Isolated Skull Fractures in Children. Annals of Emergency Medicine, 71(6), 714–724.e2.</ref><ref name="Powell" />:
+**Neurologically normal
+**Isolated closed linear skull fracture
+**No concern for [[non-accidental trauma]]
+*Admit all others
-o    linear fx most common- then depressed and basilar
+==See Also==
+*[[Head Trauma]]
+*[[Skull fracture]] (Adult)
+==External Links==
--    most fxs have hematomas
+==References==
+<references/>
--    larger hematoma more likely to have fx
+[[Category:Trauma]]
+[[Category:Pediatrics]]
--    basilar skull fx usually have hemotympanum, battle sign, csf leak, CN palsy
+[[Category:Neurology]]
--    30% of linear skull fx have intracranial inj but 40- 100% of intracranial inj assoc with fx
--    linear fx heal without complication except growing skull fx
--    growing skull fx- enlarge overtime producing cranial defect- from tear in dura.  CSF pulsation or meninges herniation and bone remodeling.   Usually >3mm separation and present 18 mo after initial injury. Most need surg
--    depressed skull fx- complications include intracranial hem, dural laceration, sz, focal neuro,
--    basilar skull fx- bleed into middle ear, mastoid air cells, csf leak  and meningitis,, hearing loss, CN 6-7-8 defect- transient or permanent
--    no prophylactic abx- leaks usually stop in 1 wk
--    plain xrays better than ct to dx skull fx but still need ct to eval brain
-[[Category:Peds]]