Head Injury, Skull Fracture

Skull fractures may be of two types:

• A closed, or simple, break in the bone without breaking the skin or bone covering (periosteum).
• An open, or compound, break that breaks the skin and periosteum.

BODY PARTS INVOLVED

• Skull.
• Periosteum (fibrous covering of bone).
• Soft tissue adjacent to the skull, including skin and underlying tissue, muscles, nerves and tendons.
• Brain (sometimes), if bone fragments are depressed into the brain.

Causes

Direct blow to the head.

Signs & Symptoms

• Pain and swelling over the skull fracture.
• Bruising over the fracture and around the eyes and nose.
• Profuse bleeding from the scalp if the skin is broken.
• Leakage of clear fluid (cerebrospinal fluid) into the ear or nose.

Additional signs, if brain damage accompanies the skull fracture:

• Drowsiness or confusion.
• Vomiting and nausea.
• Blurred vision.
• Loss of consciousness-either temporarily for long periods.
• Amnesia or memory lapses.
• Irritability.
• Headache.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

The extent of injury can be determined only with careful examination and observation. After a doctor's examination, the injured person may be sent home, but a responsible person must stay with the person and watch for serious symptoms. The first 24 hours after injury are critical, although serious aftereffects can appear later. If you are watching the patient, awaken him or her every hour for 24 hours. Report to the doctor immediately if you can't awaken or arouse the person. Report also any of the following:

• Vomiting.
• Inability to move the arms and legs equally well on both sides.
• Temperature above 100F (37.8C).
• Stiff neck.
• Pupils of unequal size or shape.
• Convulsions.
• Noticeable restlessness.
• Severe headache that persists longer than 4 hours after injury.
• Confusion.

MEDICATION

Don't give any medicine-including non-prescription acetaminophen or aspirin-until the extent of injury is certain.

Home Diet

Follow a full liquid diet for 24 to 48 hours until the danger of complications passes.

Prevention Tips

• Teach children to obey traffic rules and signals.
• Wear a protective helmet or other appropriate headgear during athletic activity in which head injury is possible.
• Provide highly visible clothing.
• DO NOT leave the victim alone, even if there are no complaints or obvious injuries.
• Use car seats or seat belts whenever in a motor vehicle.
• Do not allow children to bike or skate at night.
• DO NOT allow the victim to continue to engage in physical activities.