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Pediatric Skull Fractures: Demographics, Injury Patterns, Associated Injuries and Treatment in 923 Consecutive Patients
Oluwaseun A. Adetayo, MD, Sanjay Naran, MD, Christopher M. Bonfield, MD, Ian F. Pollack, MD, Joseph E. Losee, MD.
University of Pittsburgh Medical Center
2013-02-28
Presenter: Oluwaseun Adetayo, MD
Affidavit:
This work, in its entirety, represents the original work of the resident.
Director Name: Joseph Losee, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND:
Pediatric skull fractures are a unique subset of injuries that pose distinct management and treatment challenges. They are anatomically distinct from their adult counterparts and affect brain and craniofacial development. The aim of this study was to characterize the demographics, injury patterns, associated injuries, and treatment for this patient population.
METHODS:
A retrospective review of patients less than 18 years of age presenting between 2000-2005 with skull fractures was performed.
RESULTS:
923 patients met our inclusion criteria, the significant majority of which (63.6%) were male (p<0.01). 82.4% were admitted, of which 27.1% required ICU care. Average age at injury was 5.97±13.35 years. 19.2% had associated facial fractures, and 23.4% had other severe associated injuries. 150 patients required interventions: 42% for traumatic brain injury, 41.3% for skull fractures, and 16.7% for associated facial injuries. Fracture patterns, level of care, and cause of injury varied by age. In 30% of the intervention group, late sequelae such as post-craniotomy contour and soft tissue deformities, growing skull fracture, seizures, headaches, learning disability, and wound healing complications occurred. There was one mortality. Male subjects, victims of falls, and patients with direct trauma to the head were significantly more likely to sustain skull fractures (p≤0.01).
CONCLUSIONS:
For pediatric patients presenting with a skull fracture, injury patterns are significantly correlated with gender and mechanism of injury. Management requires a multidisciplinary approach. A better understanding of this fracture population will enable practitioners to better identify patients at risk, injury patterns, and late sequelae of pediatric skull fractures.
