Open Skull Fracture
Last Updated: October 1, 2018
The appropriate management strategy (operative versus nonoperative) for a depressed skull fracture continues to remain controversial.
Closed linear fractures, even if depressed, may be left untreated if there is no significant underlying expanding hematoma or mass lesion. A cosmetic deformity may justify operative intervention.
However, compound fractures (open to the outside with an associated skin laceration) coupled with suspected dural tears are indications for neurosurgical intervention because of their high likelihood of subsequent infection and abscess formation. Unfortunately, it is no reliable method to discern if the dura has been violated based on clinical findings or neurologic imaging, thus necessitating neurosurgical exploration.
It is reasonable to expect some form of u...