Surgical aspect of head injury Ref=short practice of surgery

1. Skull fractures
Extradural hematoma
shakerHaneen Hassan
Alkindy college of medicine
Refrences/ Bailey and love’s short practice of surgery 26edition

2. Skull fractures:
•Closed linear fractures
is a break in a cranial bone resembling a thin line, without
depression, or distortion of bone.
are managed conservatively, with primary closure of associated
wounds where possible.

3. •Skull base fractures
is a fracture of the base of the skull, typically involving the
temporal bone, occipital bone, sphenoid bone, and/or ethmoid
bone.
Physical Exam

4. A 20-year-old girl was admitted as an emergency to
the regional trauma centre in the early hours of the
Morning ,exposed to severe trauma of the head.
At the scene she was noted to have a
• Glasgow Coma Score of 3
• with a fixed, dilated left pupil.
A hard collar was applied immediately and
she was transferred to hospital. On arrival, she was
ventilated and was haemodynamically stable. Full
primary and secondary survey only revealed left
otorrhoea and some bruising in her left shin.

6. • Prophylactic antibiotics are not usually required, even in the
case of CSF leak, which generally resolves spontaneously
without the need for craniotomy and repair.
• Fractures which involve the air sinuses may be managed as open
fractures, using broad spectrum antibiotics

7. Depressed skull fractures involve inward displacement of a bone fragment
by at least the thickness of the skull .
• They occur when small objects hit the skull at high velocity.
• They are usually compound (open) fractures,
• associated with a high incidence of infection, neurological deficit
Most compound fractures will require exploration, debridement and
elevation of the fragment.
Prophylactic treatment with a course of broad spectrum antibiotics is
normal practice

8. • Bleeding that occurs in the dura between the skull and the
brain
• is a neurosurgical emergency.
• It results from rupture of an artery, vein or venous sinus, in
association with a skull fracture. Typically, it is damage to the
middle meningeal artery under the thin temporal bone.

9. Presentation
• loss of consciousness, is sufficient to start the extradural
bleeding.
• The patient may then present in the subsequent lucid interval
with headache
• without any neurological deficit.
.

10. after as long as some hours ~~rapid deterioration follows.
• cardinal signs of brain compression and herniation
• There is contralateral hemiparesis
• reduced conscious level and ipsilateral pupillary dilatation

11. On CT,
• extradural hematomas appear as a lentiform (lens- shaped or
biconvex) hyperdense lesion between skull and brain,
• A skull fracture will usually be evident.

12. Extradural haematoma requires immediate transfer to
the most accessible neurosurgical facility, for
immediate evacuation in deteriorating or comatose
patients or those with large bleeds, and for close
observation with serial imaging in all cases.
Overall mortality is around 10–20 per cent