Head Injuries Scalp and Skull Fractures

Prepared by : Ahmad Abid Bin Abas07-6-02

Classification1) Circumstances :

a) Accidental in RTA,accidental falls and fall of object on head accidentally. b) Homicidal c) Suicidal

2) Instruments : a) Blunt

b) Sharp c) Firearm weapons

3) Anatomical : skull,meninges,brain or any combination of these.4) Other :

a) Impact injury : When localized object strikes the head will lead to local effects.b) Acceleration/Deceleration : Injury due to sudden movement of head.

e.g concussion,subdural hemorrhage in shaken baby syndrome.

Scalp Injuries• Layers of Scalp :

Scalp Injuries

• Types of wounds present in scalp :Incised wounds - caused by sharp instrument e.g knife,blade of

axe

3) Cut laceration

• Commonest injury.May be accidental or homicidal.

4) Scalp Avulsion with skin loss with a small depressed fracture in the frontal region.

5) Contusion,hematoma.

• Could be subcutaneous,subgaleal or subperiosteal

6) Firearm Wounds

• in the form of inlet or exit, or only inlet.

Medico legal importance of scalp wounds :

• They bleed freely but heal quickly,less liability to sepsis.

• If got septic,it may affect the bone in the form of superficial necrosis.

Skull Injuries

• In the form of fractures which either affect the base,vault of the skull or both.

• Fracture Base. – It may produced by :a) Forces applied directly to base through spinal

column (e.g fall from a height on the buttocks) or face.

b) Extension from fracture vault.

Skull Injuries

Factors affecting the production of skull fractures :

• Force of the blow = momentum• Size of the striking surface area of instrument

used.• Position of head at time of the blow.

(supported or not)• Size of the blow.• Covering of the hair.

Fissured Fracture/Linear/Hairline

Fissure fracture of the vault of the skull running from the right temporal region

to the left temporal region.

Fissured Fracture/Linear/Hairline

Characteristics of Fissured Fracture• 1) Instrument used is heavy blunt with wide striking surface area

and moderate to low momentum.2) Single or multiple.3) Occur alone or with other types of fracture.4) Site : starts at site of application of force and runs parallel to its direction.5) The beginning of fissured fx is more wider than its end.indicates position of the assailant.6) The common site is the base of skull.7) Traumatic separation of suture.(traumatic diastasis of a suture).8) Usually accompanied by signs of brain concussion/compression due to ext.hemorrhage.9) Healing : Complete union of fissured fx occurs from 3-6 mnths.

Depressed Fracture

Depressed: a break in a cranial bone (or "crushed" portion of skull) with depression of the

bone in toward the brain.

Compound: a break in or loss of skin and splintering of the bone. Subdural hematoma

(bleeding) may occur.

Depressed Comminuted Fracture

• Caused by heavy blunt instrument with wide striking surface area and big momentum.

• Gutter fracture is a depressed comminuted fracture but has the shape of gutter.Gutter fracture : A long, narrow, depressed fracture of the skull.

Depressed localized fracture is of three types :

1) Depressed localized where the bones are depressed and intact.

2) Depressed localized with partial comminution.3) Depressed localized with comminution.

Cut Fracture

• Caused by heavy sharp cutting instrument or by light sharp cutting instrument.

Chipped Fracture

• Caused by blade of heavy sharp cutting instrument passing tangentially at special sites.(eminences,mastoid process)

Pond Fracture

• Depressed fracture.Occurs in infant where the bones are thin and elastic.From a blow of a blunt object or by the obstetric forceps.

Surgical Interference in Fractures

1) Burr Hole - done for exploration,on top of fissured fracture or for decompression in

depressed fracture or haemorrhage.

2) Nibbling - Done by use of nibbling forceps,giving the bone serrated edges.