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Pediatric Skull Fractures: Demographics, Injury Patterns, Associated Injuries, Operative Indications, and Outcomes in 923 Consecutive Patients
Sanjay Naran MD, Oluwaseun Adetayo MD, Christopher Bonfield MD, Ian Pollack MD, Joseph Losee MD
Department of Plastic Surgery, University of Pittsburgh School of Medicine
2015-03-09
Presenter: Sanjay Naran, MD
Affidavit:
I attest that the project here in listed is the original work of the submitting resident.
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Pediatric skull fractures pose distinct management and treatment challenges. Our goal was to characterize demographics, injury patterns, associated injuries, and treatment for this population.
Patients <18yrs presenting since 2000 with skull fractures were reviewed. Demographics, injury mechanism injury, associated injuries, fracture patterns, surgical intervention, complications, and outcomes were analyzed. Groups treated non-operatively (NonOP), operatively (OP) for skull fracture repair, and for traumatic brain injury (TBI) were compared.
923 patients were reviewed, 63.6% were male (p<0.01). Age at injury was 5.97±13.35yrs.150 patients required interventions: 42% for TBI, 41.3% for skull fractures (OP),16.7% for associated facial injuries. NonOP group was significantly younger. TBI group had a lower initial GCS score. Frontal bone fracture was seen most in OP and TBI groups, versus parietal bone fracture in the NonOP group. TBI group was more likely to have 2 or 3 skull bones fractured. In the OP group, 36.2% had a complication (38.0% intervention related, 62.0% trauma related). Sequela included contour deformities, growing skull fracture, seizures, headaches, learning disability, and wound complications. In the TBI group, 48.7% suffered a complication, most (90.6%) related to the trauma. Males, victims of falls, and direct skull trauma were significant predictors of skull fracture (p≤0.01). Violent trauma was associated with impoverished communities.
Skull fracture injury patterns are correlated with gender and mechanism. Direct trauma and car accidents are more likely to need surgical intervention. Frontal bone fractures are more likely to require repair. Patients treated for TBI have a greater incidence of 2 or 3 skull bone fracture.
