Among the most dangerous injuries is an open skull fracture. Loss of blood, damage to parts of the brain, pinched or ruptured nerves lead not only to loss of vision, hearing, but also to a person’s life itself. Prevention fatal outcome entails complex treatment, long rehabilitation.
According to statistics, every tenth injury identified by x-ray is recognized as a fracture of the skull bones. The majority of patients are middle-aged men who got into drunken conflicts with a criminal nature.
Individuals are at high risk of serious injury if they:
An open fracture of the bones at the base of the skull occurs after applying force to the base of the nose, lower jaw. But statistics reflect numerous cases of damage to the vault, extended by a fracture line to the cranial base (from 30% to 60%).
A split occurs in the occipital, temporal, sphenoid, ethmoid bones, or several at once.
Some cases of cranial fractures are the result of neglect of small children, which has led to children falling and hitting their heads. Bone structure small child is not sufficiently formed, so the risk of damage is higher. Cranial cracks most often extend from the injured vault.
In almost half of the cases, compression and brain damage result in death. The complex structure of the skull is characterized a large number vessels, bones, nerves, air structures. Violation of integrity occurs as a result of damage of a direct or indirect nature:
Traumatic brain injuries open view recognize cracks and fractures without bone displacement. Subsequent recovery is associated with favorable prognoses. Penetrating type injuries with bleeding, cerebrospinal fluid through the nose, the auditory openings pose a great threat to life.
The reason lies in the displacement of bone fragments, ruptures of the meninges - as a result, infection of the internal structures occurs.
The basis for determining the nature of the injury is the location of the injury, the characteristics of the fracture, and the severity of the injury. IN international classification diseases (ICD-10) provides classes of diseases and lists of types of cranial fractures.
Formed after a blow to the scalp. Damage to the internal plates of the bone manifests itself as wounds and hematomas. Persons under narcotic or alcohol intoxication are more susceptible to this type of injury.
By location, lesions of various structures are distinguished:
Dentists, otolaryngologists, and surgeons are working on damage to the facial area. maxillofacial departments. Neurosurgeons deal with injuries to the base of the skull that involve the brain.
Injury to the base of the skull is the most dangerous wound with a survival rate of about 50%.
The nature of the fault determines:
The fracture is characterized by:
The clinical picture is formed by fractures of the cranial fossae: anterior, middle or posterior.
Mechanism cranial fracture associated with rupture of the dura mater of the brain. Cavity formation with external environment leads to nasal and ear liquorrhea (leakage of cerebrospinal fluid) mixed with blood. Disorders of nutrition and metabolism of the brain, the penetration of infectious agents into the contents of the skull create a great threat to human life.
The occurrence of hemorrhage in the periorbital tissue (raccoon eyes), subcutaneous emphysema, post-traumatic pneumocephalus is associated with damage to the plate of the ethmoid bone of the brain, fracture of the bones of the anterior fossa of the skull.
The manifestations of symptoms are related to the etymology of the wound.
General negative conditions manifest themselves:
The clinical picture is determined by the location and nature of bone destruction.
The formation of bruises continues up to three days after the injury. Subcutaneous emphysema appears as a result of damage to the airways and destruction of the geometry of the cellular bone.
Characteristic symptoms:
Hemorrhage into the tissue eyeballs gives additional symptom exophthalmos (bulging eyes). The appearance of bruises around the eyes is a sign of a fracture of the anterior fossa. There are disturbances in coordination in space of all senses: hearing, smell, vision.
A common injury among skull lesions, up to 50% of cases. Damage to the lateral parts of the skull affects the inner and, to a lesser extent, the middle ear. The facial nerve is affected.
The following symptoms occur:
There are transverse, oblique, and longitudinal fractures. Their distribution includes bone thinning and holes. Impacts to the occipital region cause pyramidal fractures temporal bone.
A dangerous condition with impaired respiratory and cardiovascular functions.
Symptoms of damage:
Possible manifestation of bulbar syndrome as a result of damage cranial nerves: paralysis, paresis of the larynx, palate, tongue.
Analysis of symptoms and manifestations of cerebral disorders forms the basis of the primary diagnosis of the victim
The following are subject to assessment:
Additional hardware studies are carried out: radiography in two projections, MRI, computed tomography, echoencephalography.
In case of intoxication, serious condition of the patient, with disruption of vital functions important systems, the diagnosis is made to the patient based on clinical data.
After stabilization of the condition, the necessary radiography and other studies are carried out to clarify the diagnosis and determine therapeutic measures.
The manifestations of craniocerebral lesions in young children differ significantly from the symptoms characteristic of adults. Diagnosing injuries is more difficult. The consequences affect the development of the child’s body.
On the one hand, the ossification of the child’s skull is not complete, the tissues are plastic, the joints are loose. Hemorrhages and splinter fractures occur much less frequently than in adults. Nerve centers and the blood circulation of the brain are not completely differentiated, which ensures the child’s compensatory capabilities.
On the other hand, damage to immature brain structures leads to developmental disorders. Among the consequences are epilepsy, hearing and vision damage, mental retardation, etc.
The most common causes of traumatic brain injury are:
The child is more often hit by the parietal region of the head, much less often by the frontal or occipital region. Loss of consciousness in a child is almost never observed, unlike in schoolchildren and adults.
The main symptoms of injury are screaming, restlessness, refusal to eat, and vomiting. Temporary improvement may cause misconceptions about recovery. But the child’s condition can change dramatically: from drowsiness to the comatose stage.
Open craniocerebral injuries are often identified as cracks. Swelling appears in the area of the linear fracture. Timely consultation with a doctor reduces the risks of complications and manifestations severe consequences.
The victim after receiving a cranial injury needs emergency measures help. While waiting for paramedics, the wounded person, if he is conscious, can be placed on his back. In case of unconsciousness - on one side with the body supported on a cushion of things and clothing. Remove all items of clothing that restrict movement: belts, waistbands. Unfasten the buttons in the neck and chest area.
The head must be turned slightly and held still so that you cannot choke on the vomit. Transport immobilization is performed from available materials.
Bleeding is stopped with a bandage gently pressed to the wound. The development of swelling at the site of injury can be reduced by applying ice wrapped in a cloth or a bottle of cold water. Cleanliness should be checked respiratory tract, eliminate mucus and blood clots to avoid asphyxia, and prevent tongue retraction.
Medicines are administered only by doctors ambulance. If the called team is delayed, it is allowed to take an anesthetic provided that the swallowing reflex and consciousness of the victim are preserved.
Character medical care depends on the severity of the fracture and the patient’s health characteristics. Once the diagnosis is made, conservative treatment is prescribed or surgery with subsequent therapy.
Neurosurgeons remove fragments, blood clots, necrotic tissue, eliminate vascular damage, and treat wounds. Operations are necessary in case purulent inflammation in areas of damage.
IN therapeutic treatment the following drugs are used:
Linear fractures are amenable to successful treatment, without aggravating consequences. A fracture of the base of the skull leads to disability if doctors manage to save the patient’s life.
Treatment of patients with skull injuries is long-term. Bed rest, wearing an adhesive shingle bandage, rehabilitation procedures. The outcome largely depends on the nature of the injury, general condition the victim.
Statistics show that most dangerous fractures are the result of a person’s frivolous attitude towards health and life. A hospital bed is not the most joyful place, so you need to protect yourself and your loved ones from dangerous injuries.
It should be noted that it is also quite dangerous. The skull bone is considered one of the strongest in human body. However, 10 percent of all fractures occur in this part of the body. Such damage can occur with very strong physical impact on the head. For example, during:
When a head injury occurs, the following types of disorders occur:
There are no specific symptoms that differentiate a head contusion from a fracture. It is impossible to diagnose the nature of the injury on your own. If you suspect even a minor head injury, you must go to the hospital. There are traumatic brain injuries that are initially asymptomatic and then lead to irreversible consequences, even death.
All skull fractures are divided into:
In the second option, the bone, brain and its membranes are damaged. A fracture of the base of the skull is usually characterized by cracks that extend into the area of the nose, eyes and may affect the ear canal.
All damage also varies in nature:
After strong blow head may cause bruise, bone damage, fracture of the base of the skull. Symptoms directly depend on the form and severity of the injury. However, there are some manifestations that may indicate a fracture of the base of the skull:
There are some signs that are characteristic of a certain type of damage, these are:
What does a linear, depressed, comminuted, basal skull fracture look like? The photos fully prove the seriousness of such a dangerous condition.
In the event of a skull injury, timely diagnosis can save lives. The patient, who is conscious, is initially given a visual examination. The doctor asks about the circumstances of the injury, writes down symptoms, and carefully examines the injured area. In addition, the specialist conducts a neurological examination, checks the reaction of the pupils, various reflexes, and measures blood pressure. After which, to confirm the diagnosis, a instrumental examination using x-rays.
Pictures are taken in two projections. Additional MRI or SCT procedures are often prescribed. What threatens a person who has been diagnosed with a basal skull fracture? Consequences. The patient’s lifestyle after such an injury can change dramatically, and not in better side. The doctor briefs the patient and prescribes treatment. If the patient is unconscious, the diagnosis is made only by visual examination. If the outcome is successful, it is later confirmed with the help of additional examinations.
Treatment for a skull fracture may vary from case to case, depending on the severity of the injury. There are two types of treatment for such fractures:
The first type of treatment is used in mild cases, and sometimes in moderate ones. Conservative treatment:
Bed rest and complete calm are always prescribed. The duration depends on the severity of the condition. Various anti-inflammatory drugs, antibiotics and nootropics are also used.
As a rule, after minor injuries, complete recovery occurs. The situation takes a little longer if it is a fracture of the base of the skull. The consequences are different. For some, complete recovery occurs, for others, the injury leads to disability.
Fractures such as comminuted and depressed fractures require immediate attention. surgical intervention. The doctor removes fragments from the cranial cavity and foreign objects. Damage to blood vessels and arteries is especially dangerous. They lead to the formation of hematomas, which must be immediately removed and the bleeding stopped. In such cases, the mortality rate is very high. The survivors will long-term treatment and rehabilitation.
In mild cases of head trauma, the prognosis is usually good. If there is an injury such as a bruise, concussion varying degrees or basal skull fracture, the survival rate is almost 100 percent. As a rule, such patients are completely cured. After therapy, patients may suffer from headaches, migraines, dizziness, and weather dependence. These symptoms may go away over time or accompany the person throughout life.
The situation is worse with severe fractures of the fragmented and depressed type. Also, complex conditions include an open fracture of the base of the skull. Survival for such injuries is usually 50 to 50. Some patients do not even survive to operating table. Others die within the first day of surgery. Usually, after this time, the chances of life increase many times over. Such patients can either be completely rehabilitated or remain disabled. It all depends on the severity of the injury. In any case, the rehabilitation process is long and painful.
Rehabilitation in mild cases is quick and without consequences. It includes:
Often such patients are treated at home. TO minor injuries heads can be classified as:
The lifestyle of such patients, as a rule, is the key to successful treatment.
For severe skull fractures, rehabilitation is long and painful. Most dangerous forms such states:
The lifestyle of such patients changes greatly. Not everyone will be able to return to their usual behavior. Such patients spend a long time in the hospital. Then transferred to home treatment. Patients with this diagnosis are often recommended to visit a sanatorium. Rehabilitation can take years.
What should you consider if your child is diagnosed with a basal skull fracture? Consequences. The baby’s lifestyle can change significantly, so parents try to ask the doctor in as much detail as possible about the severity of such damage. Head injuries in children occur frequently, contrary to the general belief that a child’s skull is stronger than an adult’s. Doctors unanimously say that this is not so. Children themselves are very active and inattentive. Sometimes it’s hard to foresee trouble in time. Linear fracture, fragmentation, depressed, fracture of the base of the skull - in children, such injuries account for 70 percent of all head injuries. Symptoms, diagnosis and treatment are no different from adult injuries. In such cases, special children's medications may be recommended to improve cerebral circulation.
For any traumatic brain injury, contact medical institution Necessarily. If the victim is conscious, he is placed on his back until the ambulance arrives. You can apply cold to the damaged area. In difficult situations, when the patient does not respond to external stimuli, it must be carefully laid on its side and supported with soft improvised objects. It is also necessary to support the head with something soft, such as clothing or pillows, so that the victim does not choke on his own vomit. Plus, this will prevent your tongue from sticking. You need to call an ambulance as soon as possible, saying that the person is in in serious condition. It is not recommended to do anything else until the doctors arrive. It is strictly forbidden to feel the victim’s head yourself.
The base of the skull is a very serious injury that can lead to the most severe consequences, and in some cases, death. The basis of all existing risks, in in this case, is the close proximity of the cranial bone to the brain and nerve plexus. If certain parts of these organs are damaged, a wide variety of consequences can occur.
More often this type of fracture occurs in athletes, people involved in in an active way life, or in persons belonging to the category of disadvantaged or antisocial groups. It should be said that none of us is immune from this injury, since the reasons for its occurrence can be very diverse. This could be a direct blow to the head or jaw area, a car accident, certain sports, or a fall from a height. Despite the strength of a young body, such injury is most common in young and middle-aged people.
Table of contents:Like any other, a fracture of the base of the skull is divided into several types:
A fracture of the base of the skull is difficult to confuse with another injury, since it is characterized by certain symptoms that depend on the classification described above, the intensity and area of injury.
These include:
The main manifestations are:
Primary diagnosis is carried out on site upon arrival of medical assistance. It consists of interviewing the patient, examining the area of injury and the entire patient for the possibility of concomitant injuries. The pupils are also examined and their reaction to light is checked. The pulse is counted and the heartbeat rhythm is determined, and a brief neurological examination is performed. The symmetry of the face and the likelihood of paralytic phenomena in the facial muscles are checked.
Upon the patient’s arrival at the medical facility, it is necessary to carry out additional examination methods, which include:
Period full recovery a person after a fracture of the base of the skull takes long time, the exact treatment is determined after a complete diagnosis.
The basis for a favorable outcome of the consequences of injury is the timely provision of first aid to the patient.
Emergency medical care is as follows:
When you receive a brain injury associated with a fracture of the bones of the base of the skull, there is a high risk of developing purulent inflammatory processes in the brain, since pathogenic microflora can easily penetrate through the wound. To prevent this condition, all patients are prescribed a course using drugs wide range actions. In case of development purulent process, it is possible to administer antibiotics endolumbarally.
Please note
Several doctors treat a patient with a skull injury: an otolaryngologist, an ophthalmologist and a neurologist. Depending on the severity of the injury, aggravating factors and the susceptibility of the patient’s body, a treatment plan is drawn up.
This method is used for minor injuries or damage moderate severity. It includes assigning the patient strict bed rest, with elevated top part torso. The patient undergoes a lumbar puncture (every 2-3 days), coupled with the use of dehydration therapy. If treatment dynamics are positive, the patient is discharged with recommendations to limit physical activity for 6 months and systematic observation by specialists.
For acute indications, neurosurgical surgery is prescribed.
Indications:
All indications for surgical intervention pose a direct threat to the patient’s life.. The essence of the operation is craniotomy and direct elimination of the problem. This may be the removal of bone fragments, pus, or extensive hematoma. Afterwards, if possible, the patient is fitted with a piece of the missing bone or a special plate.
The survival rate for basal skull fractures is about 70%. Of course, this depends on the severity of the injury, as well as the timely and qualified provision of medical care, and the provision of first emergency aid is a highly important factor.
At closed fractures, without displacement of the skull bones, the prognosis for the patient’s recovery is quite favorable. In the opposite case, the situation looks much more complicated due to the possibility of infection. In such cases, even with the required therapy, there is a high probability of developing consequences (this may be encephalopathy, the risk of developing). Also, a fracture is accompanied by high blood loss, which, in large volumes, can cause the development of coma with aggravating factors.
Any fracture entails certain consequences; in case of injury to the base of the skull, they can be direct (occurring immediately at the fracture or shortly after it) and remote (appearing several months and even years after the injury).
Direct consequences:
The human skull is a collection of twenty-three different bones that are connected together and perform protective function brain and sensory organs, and are also their repository.
A skull fracture is quite dangerous injury, in which there is a huge percentage of mortality or disability of the victim. Subsequent treatment and its effectiveness largely depend on providing first aid to the victim and hospitalizing him in a medical facility.
A skull fracture in a child occurs in 30% of all cases of this injury, and precisely in at a young age there is the greatest risk of death, prolonged coma or subsequent disability.
There are closed (without damage to nearby soft tissues) and open skull fractures (with damage to skin).
Injuries are also distinguished by their traumatic nature:
Skull fractures most often occur for the following reasons:
Depending on the nature and severity of the damage that occurred, the signs may differ slightly from each other, but experienced doctors have identified general symptoms skull fracture, which will significantly help in diagnosing it:
As soon as such signs are detected, immediately seek qualified assistance and adequate treatment.
First of all, as soon as there is a suspicion of skull fractures - call an ambulance, which can immediately provide necessary help and stabilize the victim's condition.
If the victim is conscious and his condition seems stable, place him in a horizontal position, under no circumstances using pillows. Next, you need to completely fix the head and upper part. human body using improvised objects. The wounded area must be treated with any antibacterial agents and apply a sterile bandage to it. If the ambulance team is delayed, use ice compresses to improve the patient’s condition. If no problems with respiratory functions are found, give the victim any painkiller.
In a state of unconsciousness, the patient is also placed on a hard surface, but in a sideways position, the head of the injured person is turned on its side so that vomit that may occur during injury does not cause aspiration. All items of clothing and accessories must be removed, and the victim’s body must be secured in a half-turn using bolsters or a blanket.
If respiratory function suffered a disruption in their work, then the victim needs to undergo a procedure artificial respiration. In case of intense hemorrhages and falls blood pressure use a solution of polyglucin or gelatinol, which is administered to the patient intravenously. If the victim is in an excited state, then there is a need to administer the drug suprastin.
You need to approach the pain relief procedure very responsibly, since some medications can increase the intensity of hemorrhage.
First of all, upon arrival at the medical facility, the doctor finds out from the patient or his accompanying person the reasons for the occurrence of this injury and its first signs.
Then, in order to rule out neurological damage due to a fracture of the skull bones, the doctor conducts a study to determine the correct functioning of the senses, muscles and reflexes. The pupils of the eyes are also examined to understand whether they have a reaction to light rays, the stability of blood pressure and the position of the tongue are checked.
After confirming or excluding neurological abnormalities, the doctor proceeds to installation accurate diagnosis. To establish the nature and identify the presence of injury, a qualified doctor prescribes full examination using radiography in two projections, as well as computer and magnetic resonance imaging.
Very often the unstable condition of the patient interferes with diagnostic methods and confirmation of the diagnosis, and the structure bone tissue does not detect skull fractures. In such situations, doctors prescribe treatment based on their professionalism and the signs of damage.
Depending on the severity of the injury, an experienced specialist chooses treatment tactics; it can be either conservative or surgical.
The conservative method of treatment consists of following all recommendations prescribed by the doctor. The main thing in this therapeutic method– adhere to strict bed rest. The patient undergoes the procedure every 2-3 days. lumbar puncture to reduce the amount of fluid that enters the organs during injury. Doctors also perform a subarachnoid insufflation procedure. In parallel with this, the patient must take medications that are aimed at reducing the production of cerebrospinal fluid - diuretics.
Physical stress should be avoided for six months. The patient must be registered in the trauma and neurological office for some period after recovery.
In case any more are needed healing methods, then the doctor will prescribe them individually for each patient.
For severe injuries, treatment is performed through surgery. Its task is to remove broken bone fragments and tissue areas that have undergone necrosis. And also during the operation, experienced specialists pump out the blood accumulated in the organs, and the condition is normalized nerve endings and vessels. Similar manipulations are carried out under general anesthesia.
Internal intervention may also be required when a purulent infection occurs during a fracture, and antibiotics and other medications are unable to cope with it. In such cases, surgical intervention is prescribed by a qualified neurosurgeon who has fully studied the patient’s medical record and the nature of the existing injury.
After complete completion treatment is started rehabilitation period. It is aimed at developing and restoring motor functions of the human body, since with prolonged immobilization, muscle atrophy often develops, and performance is significantly deteriorated because of this. Rehabilitation consists of compliance correct mode nutrition, exercise physical therapy, visiting specialized massage and physiotherapy procedures. Duration recovery period also depends on the diagnosis and is determined by your attending physician.
If treatment is not provided in a timely manner or if medical recommendations are not followed, symptoms may develop. unpleasant consequences after a skull fracture:
