Fracture of the base of the skull: symptoms, survival, consequences. Fracture of the calvaria is a serious injury that requires immediate qualified assistance.

A fracture of the skull is a violation of the integrity of its bones. Such an injury is very dangerous because it is most often accompanied by brain damage. It can occur as a result of a strong blow to the head, in a car accident and when falling from a great height. Since a skull fracture can cause serious complications up to death, it is important to be able to recognize the signs of such an injury and provide first aid to the victim in time.

The main types of fracture

Skull fractures, like fractures of other bones, are usually divided into open and closed. It is generally accepted to divide skull injuries into two main groups:

As for the nature of the injury, they are divided into several types:

Perforated fracture of the skull or hole. This injury is fatal in most cases. Mostly occurs after gunshot wounds. The projectile hits the blue in the brain or flies right through, and in both cases, such an injury is incompatible with life.
Depressed skull fracture. In this case, the bones are pressed into the skull. As a result of such a fracture, damage can be blood vessels, there will be bleeding, meninges and medulla. In severe cases, hematomas and brain injury may occur. If compression of the intracranial structures occurs, then the injury is serious.
Comminuted skull fracture. It is characterized by the appearance of several fragments of the bones of the skull. They can also damage the medulla. If a fracture occurs at the confluence of the sinuses, then in most cases it occurs fatal outcome. In this type of injury, the consequences are the same as with a depressed skull fracture.
Linear fracture. It is the safest of all types of skull fractures. It resembles a thin line, in this case usually no displacement of bone fragments occurs. These types of fractures usually do not require urgent action. But even in this case, complications may arise, for example, if the meningeal arteries are injured, an epidural hematoma may appear.

Symptoms and signs

The symptoms of a skull fracture depend on the type of injury. It is important to be able to distinguish between its signs in order to properly provide first aid to the patient. Most often, linear fractures occur, they are usually uncomplicated, but hemorrhage in the middle ear and hematoma in the mastoid process or periorbital tissue can be observed. In this case, such signs help doctors diagnose a fracture when it is not visible on an x-ray.

With skull fractures, consciousness is usually disturbed, there may be both a short-term fainting and a deep coma. If the brain is damaged and cranial nerves, then usually there are violations of sensitivity, for example, paralysis.

In the event that the injury is accompanied by cerebral edema, then the victim will experience the following symptoms: nausea, vomiting, strong pain syndrome, disturbance of consciousness. When squeezing the brain stem, breathing and blood circulation are disturbed, and pupil reaction may be inhibited.

With skull injuries, there is one pattern: the more the consciousness is disturbed, the more dangerous the injury. However, there is an exception to this rule that you should be aware of. With an intracranial hematoma, the patient may have a period of enlightenment, which is replaced by loss of consciousness.

Most often, when the skull is damaged, it is difficult to diagnose the fact that patients are often in drunkenness. That is why the testimony of eyewitnesses who saw how a person received a head injury is very important.

If the anterior cranial fossa is damaged during a fracture, then the patient will have the so-called “glasses” symptom, that is, hemorrhages around the eyes will become visible, cerebrospinal fluid mixed with blood can come out of the nasal passages. It is important to note that the symptom of "points" may not appear immediately, but, for example, after a day.

A fracture of the middle cranial fossa is characterized by the fact that cerebrospinal fluid can exit the auditory canals. Also, a bruise will be visible on the back of the pharynx. If there is a fracture of the posterior cranial fossa, then it will be difficult for the victim to breathe, because the brain stem is damaged, bruising in this case will become noticeable in the area of the mastoid process.

If such an injury happened to a child, then it often happens that he feels good after it, and only after some time does he develop symptoms of a fracture. For example, the patient may faint due to a sharp increase blood pressure. The point is that it is completely frontal lobes develop before the age of 16, so at this age the consequences of such injuries may become noticeable.

Diagnostics

It is important to exclude skull fractures in all people who have received traumatic brain injuries. First, the doctor must interview the patient and find out under what circumstances the injury was received, then the symptoms and general condition of the patient are evaluated.

Next, a neurological examination is needed, which includes an assessment of sensitivity, muscle strength, and reflex testing. The doctor also examines the condition of the pupils to see if there is a reaction to light. In addition, it is important to find out how the tongue is located, whether there are deviations, whether the grin of the teeth is uniform, and the pulse is also checked.

To confirm the diagnosis, it will be necessary to make a survey radiograph of the skull, it is usually performed in two projections. The results of magnetic resonance imaging or computed tomography.

Diagnosing a fracture of the skull is not easy, especially if the diagnosis is complicated by serious condition patient, then it is simply impossible to perform necessary research. Sometimes, due to the peculiarities of its structure, a fracture of the bones of the base may not be visible. When it is not possible to consider it on survey pictures, the diagnosis is usually made on the basis of the clinical picture.

First aid

All patients with an injury as severe as a skull fracture should be without fail taken to the hospital. If hospitalization is delayed, the patient should be placed in horizontal position. If a person has not lost consciousness, then it must be put on his back without a pillow.

In case of unconsciousness, he should be laid on his back in a half-turn position. It is desirable to place a roller under one side of the body, it can be made from improvised means, for example, clothes. The person's head should be turned to the side, this is done so that the victim does not choke on vomit in case of vomiting.

It is imperative to unfasten tight clothing on a person so that he can breathe freely, if there are glasses or dentures, then they must be removed. The head of the patient is calm, if there is bleeding, then you need to stop it. A pressure bandage is applied to the wound, and ice can be applied to the injury site.

If the patient is unconscious, it is necessary to check the airway patency. If necessary, they should be cleaned of vomit and eliminate the retraction of the tongue.

If there are respiratory disorders, then it is contraindicated to give the patient narcotic analgesics, as they can only aggravate the situation. Doctors usually prescribe cardiac remedies in these cases, and artificial respiration carried out through a mask. If the victim has an open wound, then he is prescribed antibacterial drugs to avoid infection.

Even if a person feels fine after such an injury, he still needs to be shown to a doctor to rule out a skull fracture. This is especially true for children, because their signs of injury may not be immediately noticeable. Otherwise, serious complications are possible in the future.

Treatment

When treating a skull fracture, doctors pay great attention to the prevention of purulent complications. For this, apply antibacterial agents a wide range actions. In addition, sanitation of the nasopharynx and middle ear is also carried out, antibiotics are instilled there.

Treatment of skull fractures can be either conservative or surgical. It depends on the severity of the injury. With relatively no severe injuries conservative therapy is indicated. The patient must necessarily observe bed rest, but the head must be given exalted position thus, the outflow of cerebrospinal fluid decreases.

In addition, dehydration therapy is performed, lumbar punctures are performed or they are replaced by lumbar drainage. Also, the patient is prescribed painkillers, diuretics and antibiotics. If there is a concussion, then nootropic and vasotropic drugs are used. In case of serious bruising of the brain, patients need to drink drugs that increase cerebral circulation.

If a purulent complication occurs during a skull fracture, then in this case, doctors administer intravenous antibacterial drugs, and also use them for endolumbar administration. The choice of antibiotics is carried out after taking cultures for sensitivity to these drugs of cerebrospinal fluid and mucus from the nose.

Surgical treatment is usually used for severe fractures, such as multi-comminuted and depressed. The operation is carried out under general anesthesia, do a craniotomy, then through the created hole, the doctor eliminates fragments of the skull bones and destroyed tissues.

Indication for urgent operation is the formation of intracranial hematomas. In this case, the doctor during the operation removes the accumulated blood, finds and eliminates the source of bleeding and rinses the cavity.

In addition, an indication for surgical intervention may be damage to the fracture of the skull of the facial and optic nerve, as well as the ongoing outflow of cerebrospinal fluid from the nasal and ear passages.

Surgical intervention is also indispensable if no antibacterial drugs can stop a purulent infection developing inside the skull. In any case, the decision to perform the operation or not is made by an experienced neurosurgeon. It takes into account the severity of the injury, as well as its type, the medical history of the victim, the condition and age of the patient.

What could be the consequences

Whether the patient will be able to return to a normal lifestyle after an injury depends on its severity and the presence of complications and comorbidities. Non-displaced fracture usually not required surgical intervention, and if it was possible to avoid purulent complications, then the prognosis is most often favorable.

In the event of infection and the development of complications, such as meningitis and encephalitis, in the future the patient may develop encephalopathy, a sharp and uncontrolled increase in blood pressure. Frequent headaches and epileptic seizures are possible.

Sometimes with traumatic brain injury profuse bleeding. It can be so massive that the victims die in the first hours after the injury, or a deep coma occurs, the prognosis in this case is usually unfavorable. At minor bleeding intracerebral hematomas may occur, they can later cause encephalopathy.

The worst complication that a skull fracture can lead to is complete paralysis of the body. Of course, this rarely happens, but it still happens, because the base of the skull is a kind of connecting element between the head and spinal cord. Usually such a complication occurs with a fragmental fracture.

Another complication may arise, of course, not as serious as the previous one - this is a curvature of the spine. If the base of the skull is injured, then the spine may not be securely attached to the skull, so the trajectory of its curves may change, and this will lead to a curvature of the spine.

In each individual case, the favorable outcome for such injuries depends not only on the severity of the fracture, but also on the timeliness and adequacy of the treatment. Often, even a skull fracture in children is well treated, so to speak, without consequences.

But still, such a trauma has a strong impact on the emotional and physical state patient and may affect mental capacity. That is why you need to be attentive to your health and try to reduce the risk of such fractures. And if it was not possible to avoid such an injury, then you need to reduce the likelihood possible complications and try to return to normal life as soon as possible.

Which doctor treats

A blow to the head with great force can break the integrity of the bones of the skull. In such cases, a fracture is diagnosed. Any head injuries are serious, they are often associated with a violation of the integrity of the brain. Damage to the skull is possible not only from a blow to the head. An injury can be caused by an unsuccessful fall from a height onto the pelvis or legs.

When damaged, a life-threatening condition develops, in which hospitalization is mandatory. Based on the severity of the injury, surgical or medical treatment is prescribed.

Types of skull fractures

Injuries to the skull may be accompanied by a violation of the skin, under these conditions, an open fracture is diagnosed. Damage may be closed. The second option is diagnosed more often.

From the blow various etiologies bones of the base or vault of the skull may be affected. On this basis, fractures are divided into groups:

If the integrity of the sphenoid, ethmoid, occipital, temporal, or several segments at once is violated, we are talking about a fracture of the base of the skull.

The mutilation is often accompanied by the formation of cracks in the bridge of the nose and orbital plates. Injuries of this nature usually cause hemorrhages in the periorbital tissue and bleeding from the nose and ears.

A fracture of the calvarium is accompanied by the presence of a wound or depression in the area of the head where the blow fell. The inner bone plate is most severely damaged, the fragments of which injure the medulla.

Trauma to the calvarium may have different character damage:

With a linear fracture of the skull, a thin crack forms in the bone. Trauma is rarely accompanied by displacement of fragments and is one of the least dangerous injuries. Usually the bones grow together fairly quickly. The most serious complication is the formation of an epidural hematoma caused by internal hemorrhage.
If a bone fragment is pressed into the cranial vault, we are talking about an impression fracture. In case of injury, a crush or contusion of the brain is usually formed, intracerebral hematomas are formed.
Similar consequences are caused by a comminuted fracture. Fragments formed during trauma damage the membranes of the brain.
A hit in the head from a firearm is the cause of an injury incompatible with life - a perforated fracture of the bones of the cranial vault. The bullet lodges deep in the brain or passes right through. Both types of injury are fatal.

Pathogenesis of injury

The mechanism of action on the bones of the skull can be both direct and indirect.

If the bone breaks at the point of impact, the fracture is called a straight fracture. If the force of the shock wave was transferred from other bones through inertia, we are talking about an indirect mechanism of damage.

A skull fracture is usually the result of a direct blow. Bones bend under the influence of force.

Fracture of the base of the skull often has an indirect character. Injury occurs from the impact of a shock wave, which is formed when falling from a great height on the legs or pelvis and is transmitted through the bones of the spine.

Symptoms of injury

The manifestations of damage can be varied depending on the location and severity of the injury.

Linear fractures are the most common and easily treatable skull fractures. Often the injury cannot be seen on x-rays. In this case, doctors rely on external signs: a hematoma forms on the periorbital tissue, a bruise may appear in the region of the mastoid process.

A fracture of the skull, as a rule, is accompanied by a violation of consciousness of varying severity, from a short syncope that occurred at the time of injury, to a long-term deep coma. Usually the degree of manifestation of this symptom is directly related to the extent of the injury. This rule does not apply to cases where an intracranial hematoma is formed. This complication is manifested by a change in periods of clear consciousness and fainting.

If the fragments damaged the nerves of the skull or the structure of the brain, sensitivity may be impaired, up to paralysis. After an injury, cerebral edema may occur. Then the clinical picture is complemented by intense pain, nausea and vomiting.

If a fracture of the base of the skull is localized in the anterior cranial fossa, within half a day on the skin around the eyes appear dark bruises(symptom of "glasses"). The injury is accompanied by bruising on the back wall of the pharynx. CSF mixed with blood is poured through the nose. Cerebrospinal fluid may ooze from the ears when the fracture involves the middle cranial fossa. Such signs give grounds to attribute damage to open penetrating injuries. fracture sphenoid bone leads to bleeding from the mouth and nose at the same time.

A significant part of the injuries of the base of the skull falls on fractures of the bones of the middle cranial fossa. Damage causes bleeding from one ear, hearing is sharply reduced or disappears. Cerebral fluid is poured out through auricle if integrity is compromised eardrum. The victim cannot maintain balance and notes some loss of taste sensations.

Damage to the posterior fossa is accompanied by trauma to the brain stem, causes difficulty in breathing and bruising over mastoid processes. Perhaps the appearance of paresis of the muscles of the larynx, tongue.

IMPORTANT! A fracture of the skull in a child may initially be asymptomatic, and only after a while the general condition of the victim begins to deteriorate.

Trauma to the skull bones of any localization may be accompanied by jumps in blood pressure, malfunctions heart rate, involuntary urination. The victim's pupils may be different sizes while not reacting to light.

Providing first aid to the injured

Traumatic brain injury of any severity is the basis for emergency hospitalization. If there is a suspicion of a skull fracture, before the arrival of doctors, the victim must be provided with competent first aid.

The victim, who has not lost consciousness, must be laid on a flat plane on his back and ensured that he remains motionless. The head must be fixed. If there is open wound it should be covered with a sterile dressing. Ice may be applied to the injured area.

IMPORTANT! When making any manipulations with the wound surface, it is necessary to avoid pressure on the injured bone.

If the injury is accompanied by fainting, the victim is laid on his side, his head is fixed with the help of rollers from improvised things. This position prevents the risk of choking on vomit. Need to check Airways the victim, in case of suffocation, artificial respiration is performed.

It is necessary, if possible, to remove any jewelry, glasses, and dentures from the head. The collar of the garment needs to be loosened.

The victim is not allowed to take painkillers of a narcotic nature, since similar funds cause respiratory failure.

Diagnosis of a skull fracture

If a person in clear mind, the diagnosis begins with a visual examination and a questioning about the circumstances of the injury. The neurological status of the patient is clarified: the doctor checks the reflexes, the reaction of the pupils, draws attention to the condition muscle tone.

The oral cavity is examined without fail: a fracture of the skull causes deviation of the tongue.

If the victim enters medical institution in an unconscious state, instrumental types of research cannot be applied. In such cases, based on the clinical picture of the injury, a diagnosis is made, and a treatment regimen is developed. Necessary diagnostics carried out later, when it is possible to stabilize the patient's condition.

IMPORTANT! Damage to the ethmoid bone opens access to air, from its penetration subcutaneous emphysema is formed.

This manifestation clearly indicates a fracture of the base of the skull and allows doctors to make a diagnosis and prescribe therapy without waiting for the results of an instrumental examination.

Treatment of a skull fracture

For the treatment of patients with injuries of the skull are most often elected conservative methods. Bed rest is the main requirement. The position of the patient should not be strictly horizontal, the outflow of cerebrospinal fluid slows down if the head is slightly higher than the body.

Fracture of the base of the skull requires treatment every 72 hours lumbar puncture. Simultaneously, with the help of subarachnoid insufflation, oxygen is introduced, equal in volume to the extracted fluid. Dehydration therapy is also carried out with the help of diuretic drugs.

In addition to liquorrhea, the victim may experience the development of pneumoencephalitis. The accumulation of air over the hemispheres of the brain leads to sharp increase intracranial pressure. Carrying out a puncture through the superimposed milling hole allows you to remove the collected gas.

If a mild or moderate fracture of the skull bones is diagnosed, drug therapy involves taking painkillers: non-steroidal anti-inflammatory drugs are usually prescribed.

If there is an outflow of cerebrospinal fluid from the ears or nose, then the cerebrospinal fluid space is open to pathogenic bacteria. To prevent the development of a purulent infection, the patient is prescribed a course of antibiotics. Diacarb and Lasix are taken to suppress the process of producing cerebral fluid.

As a rule, an injury is accompanied by a bruise or concussion, in these cases, doctors prescribe nootropics and vasotropic drugs, as well as drugs to improve cerebral circulation.

Surgical treatment of a skull injury

If conservative methods of treatment have not had a positive effect on the outflow of cerebral fluid, there is a risk of developing recurrent meningitis. In this case, surgical intervention is prescribed, during which the CSF fistulas are eliminated. To determine the exact location of the defect, an MRI is performed with the introduction contrast medium in the liquor.

During trepanation frontal area the lumen is covered by suturing the dura mater, in difficult cases are used plastic correction aponeurosis or fascia. The bone defect is corrected by applying a piece of muscle. When liquorrhea is caused by wall injury sphenoid sinus, during transnasal intervention, tamponade is performed using a muscle or a hemostatic sponge.

Violation of the geometry of the bones of the skull can lead to damage to the optic canal. The nerve is suffering from the pressure of the hematoma. The consequences are visual impairment or total blindness. In such conditions, decompression of the optic nerve is indicated; for this, the canal is opened through transcranial intervention.

Large comminuted fractures require surgical treatment with cranioplasty. First, the surgeon removes sharp pieces of bone from the wound, the defect of the cranial vault is closed with a plate that is attached to the bone. A special fast-hardening plastic is widely used for the prosthesis. Tantalum plates are also used.

Urgent surgical intervention is required if an intracranial hematoma forms. The accumulated blood is removed and its source removed.

Not always antibiotics can stop the development of a purulent infection that has entered the skull after an injury. In this case, surgical treatment is also indicated.

The decision on any surgical intervention is made by a neurosurgeon, based both on the diagnosis and on the general condition of the patient's body, on his age.

Subsequently, the patient needs Long procces rehabilitation.

Consequences of injury

With a skull fracture, the consequences of the injury are divided into two categories: those occurring at the time of the injury and manifesting later.

Direct consequences include the development intracranial hematoma, infectious inflammatory processes, damage to brain tissue by bone fragments.

Long-term effects can manifest themselves months and even years after recovery. The scar tissue formed at the site of injury compresses the vessels that feed the brain. As long-term consequences, paralysis is formed, mental functions are disturbed, epiactivity may appear, an uncontrolled increase in pressure can provoke a stroke.

In the general structure of traumatism, skull fracture is 20-30%, and among the causes of death and disability resulting from trauma - 40-60%, ranking first.

A skull fracture is a violation of the integrity of the bone tissue, while penetrating, with damage to the dura mater, and non-penetrating, without violating it.

Skull fracture can be open (with damage to the skin and underlying tissues) and closed (without damage to the integrity skin). Fracture of the skull by location is divided into damage to the vault, base of the skull.

Skull fracture is the leading cause of death and disability

Fractures of the calvaria

They are divided into linear, depressed. Linear fractures go through the veins of the spongy substance of the skull, the arteries of the meninges, the projections of the passage of the sinuses of the dura mater, can injure these vessels, which leads to a significant accumulation of blood in the gap between the skull and the dura mater. Comminuted and depressed fractures damage hard shell brain and blood vessels.

The consequences of this are the formation of a hematoma located between the solid and arachnoid shells brain.

The general condition of the patient is directly related to the size of the fracture, the degree of brain damage, related complications. The clinic is formed from cerebral, focal neurological manifestations.

In the clinic of a depressed fracture, symptoms of a focal lesion may be present, epileptic seizures. Depressed fractures not less than the thickness of the bone are subject to surgical treatment as soon as possible, except for depression in the area frontal sinus.

Fractures of the base of the skull

According to the location, fractures of the anterior, middle and posterior cranial fossae are distinguished. Traumatization of the ethmoid bone is manifested by the outflow of cerebrospinal fluid, blood from the nose. To damage the integrity of the pyramid temporal bone characterized by bleeding from the ears and complete break eardrum.

For fractures of the anterior cranial fossa, bruising around the orbits, leakage of cerebrospinal fluid and blood from the nose, impaired or complete prolapse sense of smell, unilateral decrease in visual acuity.

Bruising under the eyes is typical of a skull fracture

Fractures of the middle cranial fossa often pass through the pyramid of the temporal bone, which is manifested by bleeding and leakage of cerebrospinal fluid from the ear and nasopharynx, hearing loss, impaired activity facial nerve. Fractures of the posterior cranial fossa are most severe with damage to the brain stem.

Damage to the structure of bone tissue passing through the sinuses is dangerous for the development of meningitis.

Diagnostics

Along with clinical picture fracture, help in the diagnosis is provided by:

puncture study;
x-ray examination of the skull;
magnetic resonance, computed tomography;
echoencephalography.

Features in children

The specificity of the child's body is less fragility and high elasticity of the bones of the skull.

hallmark fractures of the cranial vault, received by a child, is their "concavity", which is explained by the increased elasticity of the bone, which allows it to easily bend without breaking.

With injuries accompanied by a blow to the head on a hard surface, the sutures diverge, multiple linear fractures of the cranial vault appear - cracks.

In a child, less often than in an adult, fractures of the base of the skull, extensive hemorrhages between the arachnoid and pia mater, and intracranial accumulations of blood occur.

because of age features child, skull fractures in childhood, especially early childhood, are easier. But then they can form dangerous consequences such as hydrocephalus, epilepsy.

At baby with a fracture of the bones of the skull, loss of consciousness most often does not develop. General stun is replaced by increased motor activity. Fluctuations in muscle tone, reflexes appear dimly. On the pathology of movement, a conclusion is made on the reduced function of the damaged limbs. The child of the eldest age group the clinic is characterized by unstable cerebral manifestations and autonomic disorders. Loss of consciousness, nausea, severe vomiting, dizziness, anxiety. These phenomena are quickly replaced by apathy, lethargy, tearfulness.

In a newborn with a bulging large fontanel and other symptoms of brain compression, its puncture is recommended. The child has older help angiography, therapeutic and diagnostic trepanation of the skull provide clarification of the diagnosis.

Treatment at different stages

The recovery of the patient directly depends on the correctness and completeness of the provision medical care at all its stages.

First aid principles:

In case of a skull fracture, first aid should be immediately provided at the scene.
If the victim is unconscious, then when rendering assistance, he should not be disturbed, raised, so as not to aggravate the severity of the condition.
Immobilization - to limit the mobility of the head, to create shock absorption, to prevent shaking and shocks, the head of the victim is placed on a cotton-gauze circle or an impromptu object with the back of the head in the hole to limit the mobility of the head.
Use of Kramer splints - one of the splints is bent so that it captures the forehead, follows the contours of the head from front to back and the curve of the neck up to thoracic spine; the other is curved in the shape of the shoulder girdle and head over the first splint. When they are applied, the head tilts back a little, fixed with bandages.
Transport the victim on a stretcher, in a supine position on his back without shaking with a fixed head.
To prevent blood, cerebrospinal fluid or vomit from entering the respiratory tract, tilt your head back and turn on its side.
Simultaneously with the provision of first aid, urgent hospitalization is carried out in a specialized neurosurgical department.

Doctor's tactics open injuries of the skull consists in the primary phased careful treatment of the skin, bone, membrane, brain layers of wounds according to classical principles, preferably no later than 12 hours after the injury occurred.

When performing surgical treatment of a wound in a child, it is required to recreate the integrity of the dura mater with the help of fascia plastics, because the achievement of sealing the cranial cavity solely due to the skin most often does not prevent the outflow of cerebrospinal fluid.

In some cases, a skull fracture requires surgical intervention

In a child, single-fragment, concave more than 1.5 cm fractures of the bones of the cranial vault are a direct indication for immediate surgical treatment. This becomes especially relevant when signs of focal brain damage appear. The tactics of treatment with such consequences is justified by the fact that in an unoperated child under 3 years old, a defect in bone tissue with raised calcified edges often forms at the site of a depressed fracture after 3-12 months. This is due to trophic disorders in the bones of the skull, membranes, brain, which occurred due to prolonged detachment of the periosteum and the accumulation of blood under it.

Most often, after the successful completion of the primary surgical treatment wounds, with the removal of fragments of bone tissue, trepanation of the skull, decide the issue of primary plasty of the skull.

Contraindications for surgery:

extensive defects brain;
significant cerebral edema;
condition after removal of large hematomas, since an increase in edema is not excluded;
the presence of signs of inflammation of the wound.

After the end of surgical treatment in a hospital, outpatient care should be provided by a specialist with continued drug treatment, subsequent dispensary observation at the neurosurgeon.

When the integrity of the bones is broken, this defect is called a skull fracture. This condition is very dangerous for a person because it causes brain damage. The cause of this disease may be a blow to the head, a fall or a car accident. Well, since a fracture of the skull sometimes ends in the death of a person. It will not be superfluous to know the first symptoms that you need to pay attention to. Such knowledge will help to provide timely needed help and save the life of the injured person.

Types of fractures

Absolutely all fractures, both bones and the skull, are divided into two types, namely:

open;
closed.

This rule also applies to the skull. Defects in this department are also divided into two main groups.

First group. Fracture of the base of the skull. As a rule, in such a situation, cracks appear that extend to the nose and eye socket. In the event that the impact falls on middle fossa brain part, as a result, a crack will appear next to ear canal. This fracture provokes blood flow and hemorrhage in the eye. And it won't be hard to find it.

Second group. Fracture of the cranial vault. The symptoms of this fracture are wounds and bruising. With this type of defect, the plate inside suffers the most. Indentation of the plate leads to trauma to the gray matter. In addition, when blood vessels rupture in the shell of the brain, they form. And for , explicit pronounced signs no. This defect can be detected by the shape of the head, usually in the area hairline there will be an indentation indicating a closed-type injury.

4 main signs of a fracture

The defect of the cranium always depends on the type of damage that needs to be distinguished. This will help provide first aid. The most common are linear fractures. This type is not severe, but may appear, additional symptoms, in the form of hemorrhage in the ear. As a rule, thanks to this sign, doctors diagnose the problem much faster, since this fracture is not always visible on an x-ray.

When does a skull fracture occur? , the person may lose consciousness or fall into a coma. Well, if they are also damaged cerebral nerves then paralysis may occur.

Quite often, with such a defect, cerebral edema appears. In this case, the victim will have the following symptoms:

gagging;
Strong headache;
change of consciousness;
respiratory failure.

With trauma to the anterior cranial fossa. The victim will develop bruises around the eyes, it is also called the "spectacle symptom". Such a sign, indicating a skull injury, can appear in a person in a day.

If there is a fracture of the bones of the base of the skull, then the first sign is the cerebrospinal fluid coming out through the ears. It will be very difficult for a person who has received such an injury to breathe.

In the case when a skull fracture occurs in a child. As a rule, after such an injury, symptoms are not observed and the baby continues to frolic, because pain no. But after a while, the teenager begins to suffer from blood pressure and may even faint. This is the first signal that the skull was damaged.

How to identify a fracture

All patients who are admitted to the emergency room with suspected traumatic brain injury are checked for the presence of a skull fracture and its symptoms. Since further information depends on such data successful treatment and recovery of the patient.

The diagnosis is made in the following way. At the beginning, the doctor conducts a visual examination, additionally asks the victim questions. Then, you need to undergo a neurological examination. And only then, for a complete picture, the patient undergoes an x-ray. Additionally, the doctor may prescribe a CT scan if an x-ray is not enough.

First aid for a fracture

If a person has a suspected fracture, they should be taken to a medical facility immediately. In the case when hospitalization is delayed, the patient should be laid on his back, without a pillow.

Moreover, if a person is unconscious, he must also be placed first on his back, then turned over on his side. This must be done because the victim may choke on his vomit. When a person has vomiting, it is necessary to clean everything so that he does not choke.

And, perhaps, most importantly, even if a person feels well, he must be shown to the doctor and try to do this as soon as possible. Timely identified pathology gives a chance for a full recovery.

Treatment of a skull fracture

Any qualified physician, in case of a skull fracture, Special attention focuses on the prevention of purulent complications. For this manipulation, an antibacterial medicine. In parallel, all passages of the nasopharynx and ear are washed with an antibiotic.

As a rule, the treatment of fractures is performed in two ways:

classic;
surgical.

The method of treatment is selected, depending on how much it was damaged cranium. If the defect is relatively not severe, then the classical method of treatment is used. In this case, the victim must strictly observe bed rest, and a roller is placed under the head to avoid loss of cerebrospinal fluid.

If fracture, severe. That surgery is a must. Carry it under local anesthesia. This manipulation saves a person's life.

Important: The most effective specialist in this field is a neurosurgeon. Therefore, if a person has doubts and he wants to get competent advice, then you should contact this specialist.

Effects

Increasingly, people are asking the question, with a fracture of the skull, what are the consequences. Can the victim go back to their old way of life? In this situation, it all depends on how severe the damage is. It is also important that there was a displacement at the fracture, and what method of treatment was carried out. Basically, if there was no operation for a fracture, then the prognosis is quite positive.

In a situation where a fracture of the base of the skull is detected, the consequences are not rosy, as a rule, such an injury sometimes leads to the development of paralysis. It is worth noting that quite often and with success, people avoid such consequences. Therefore, everything depends only on the person himself and his desire to live.

Such an injury as a skull fracture is very dangerous for a person. After all, in fact, our brain is a small universe of each person. And when it happens swipe, is injured, perhaps the most important human organ. It is good if the defect does not cause irreparable harm, but there are other, more deplorable consequences. As a result, I would like to wish all people only health and may most dangerous injury skull fracture, bypasses you.

Often referred to as cranial injuries injuries of the facial bones.

Symptoms

Skull fracture:

Pain when pressing on the skull.
Paralysis, convulsions.
In open fractures, bone fragments are visible.

Bruising around the eyes in the form of glasses.
Bleeding from the nose and throat.
Bleeding from ears.
Sometimes - the expiration of liquor.
Hearing loss or deafness.
Dizziness.
Paralysis of the cranial nerves, for example, paralysis of the oculomotor nerve.

Definition closed fracture of the cranial vault in the absence of depressions ("fossae") is difficult. However, the victim is sensitive to pressure. Symptoms of a skull fracture: nausea, paralysis and convulsions. Characteristic symptoms for a fracture of the base of the skull: bruising around the eyes due to hemorrhage in the tissue of the eyes, bleeding from the nose, mouth and ears. If the dura mater is damaged, cerebrospinal fluid leaks out.

With fractures of the bones of the skull, there is a danger of falling bone fragments into the brain. The rescuer must not touch the wounds of the skull.

Causes of head injuries

Skull injuries occur as a result of force, for example, during traffic accidents (wounding a pedestrian, falling from a motorcycle, bicycle) or fights. Possible fracture of the base of the skull due to indirect force. Common cause child mortality - traumatic brain injury and its complications.

Skull injuries can be in the form of cracks, perforated or depressed fractures. Fractures as a result of depression occur as a result of a blow or a shot, while fragments of the bones of the skull enter the brain. Cracks occur under the action of blunt force, for example, cracks are formed when the skull is compressed. Skull injuries are the result of accidents, traffic accidents, or physical abuse. The use of mechanical means during childbirth is the cause of trauma to the calvaria in newborns. The newborn is characterized by depressed fractures without damage to the meninges.

Treatment

First aid for severe injuries of the skull should be provided only by a qualified doctor. First of all, it stabilizes blood circulation and ensures breathing of the victim. If you lose consciousness, the doctor will insert an endotracheal tube into the trachea and provide artificial ventilation. With open fractures of the skull, pressure is applied antiseptic dressing. Doctors at the hospital will assess the patient's condition: consciousness, breathing, pupillary response to light, and motor skills. Blood pressure, pulse, body temperature of the patient will be under constant control. The doctor will then take an x-ray of the head. Cerebral hemorrhage is established using angiography, computed tomography or nuclear magnetic resonance. At compression fracture skull and lack of bleeding align the concave bones. If a hematoma or bone fragments are removed, then after the operation, a bone defect (for example, the absence of a part of the bone) is replaced by a special plate.

Neurosurgery for head trauma

Fractures without displacement (cracks) of the vault or base are treated conservatively. Requires bed rest and rest. With open fractures, the intervention of neurosurgeons is required, because. often it is necessary to sew broken vessels.

Traumatic brain injury

Traumatic brain injuries are divided into closed and open. The latter are accompanied by rupture of the meninges. closed damage mild degree is a slight concussion; accompanied by a prolonged loss of consciousness - brain contusion.

Many people get traumatic brain injuries in car accidents, during accidents at work or at home, as well as while playing sports. Often the result of such injuries is severe brain damage.

AT last years the chances of survival of people who have suffered severe traumatic brain injuries have increased due to the use of the latest emergency medicine, intensive care and subsequent rehabilitation measures. However, the rehabilitation of people with severe brain damage is extremely difficult. It can last from several months to a year and require a lot of patience from the patient and his loved ones.

Acute stage of brain damage

Acute stage traumatic injury brain continues until the disappearance acute symptoms disease until the patient regains consciousness. The duration of this stage is 2-3 weeks, and in case of severe injury it can be delayed. Patient in acute stage is in the intensive care unit or intensive care unit.

Which treatment method to use in each specific case depends on the type and severity of the skull injury, this is established on the basis of data obtained using x-ray, computed tomography of the brain and ultrasound(for newborns until the closure of the large fontanel). In addition to neurosurgical treatment used for hemorrhages, medication is also used. When the brain is damaged, paralysis of the limbs often occurs. In the treatment of paralysis, it is necessary to start performing therapeutic exercises as early as possible in order to avoid shortening of the muscles or damage to the joints. Active movements of the patient are stimulated by soft stimuli, for example, touch, acoustic stimulation. For recovery, the help and support of loved ones is very important.

Rehabilitation

At the end of emergency or neurosurgical treatment, the next very important stage begins - rehabilitation in a specialized neurological or psychiatric department. The doctor discusses the treatment plan with the patient's relatives. Psychologists, speech therapists, specialists in therapeutic gymnastics.

If the traumatic brain injury is not complicated, then the patient is immediately discharged from the hospital home. However, in case of severe injuries, the patient is referred to a rehabilitation clinic, where kinesiotherapists, therapeutic gymnastics specialists, speech therapists, psychologists, specialists in social pedagogy or occupational therapy work.

In the hospital and rehabilitation clinic, the possibility of returning the patient to his previous job or school is being clarified. If the patient remains disabled, then discuss the use of special pedagogical measures and change professional qualifications or the opportunity to work in special workshops designed for the disabled.

Severe brain damage can lead to complete disability. Such a person may be referred to a nursing home or to a hospital with proper care. However, often, despite the difficulties, such patients are cared for at home by their relatives.

All the necessary information (on who pays for the costs of treatment, rehabilitation, addresses of hospitals and the possibility of obtaining outpatient treatment) will be provided by the following institutions:

insurance companies;
sickness funds;
social care institutions;
public organizations of the disabled;
trade unions, health departments.