Skull fracture: an indicator of life-threatening injury or a predictor of intracranial injury?
DOI:
https://doi.org/10.25305/unj.55417Keywords:
skull bones fracture, intracranial lesions, severity of traumatic brain injury, forensic examinationAbstract
Purpose. To provide arguments that would allow to bring existing today in forensic medicine evaluation of the severity of traumatic brain injury (TBI) to clinical practice.
Materials and methods. A retrospective analysis of 280 cases histories of patients been treated for TBI was provided, and 131 autopsy protocols of dead from severe TBI. Clinical evaluation of TBI severity was made according to the Glasgow Coma Scale and TBI classification. The data were statistically processed using c2.
Results. The analysis of skull fractures localization showed that mild TBI is characterized by fracture of one bone — in 38 (78.9%) cases and skull vault — in 45 (91.8%). At moderate and severe TBI fractures are localized in several bones — in 18 (50%) cases spreading on the skull base in 5 (13.8%). 57.6% skull fractures were observed in patients with mild TBI. Fractures in patients with mild TBI and concomitant intracranial injuries determines the duration of post-contusion symptoms (c2=4,9; p=0,026). CT is an obligatory examination at head trauma, also it allows to objectify the cause of the prolonged post-contusion syndrome at expert assessment of TBI severity.
Conclusions. 1. Closed scull fracture as a damage just of the bones in most cases can not be regarded as the immediate cause of death. 2. Linear scull fracture is a possible risk factor for intracranial lesions, but not a predictor of TBI severity. 3. Open penetrating head injury, multiple and comminuted fractures, skull base fractures, as well as pneumocephalus, liquorrhea indicate forming of life-threatening condition of the victim. 4. Linear fractures at mild TBI and associated intracranial injury cause prolonged existence of post-contusion symptoms.References
1. Dadabaev VK. Primeneniye metoda rentgenovskoy komp'yuternoy tomografii dlya prognozirovaniya i ustanovleniya tyazhesti vreda zdorov'yu pri cherepno-mozgovoy travme [Application of X-ray computed tomography to predict and establish the severity of traumatic brain injury] [dissertation]. Moscow (Russia): SM Kirov Military Medical Academy; 2008. Russian.
2. Ruder TD, Thali Y, Bolliger SA, Somaini-Mathier S, Thali MJ, Hatch GM, Schindera ST. Material differentiation in forensic radiology with single-source dual-energy computed tomography. Forensic Sci Med Pathol. 2013 Jun;9(2):163-9. [CrossRef] [PubMed]
3. Nikolić S, Micić J, Mihailović Z. [Correlation between survival time and severity of injuries in fatal injuries in traffic accidents]. Srp Arh Celok Lek. 2001 Nov-Dec;129(11-12):291-5. Serbian. [PubMed]
4. Khrustaleva YuA. Prichinno-sledstvennyye svyazi v sudebnoy meditsine: soderzhaniye, sposoby vyyavleniya i ikh znacheniye pri ekspertnoy otsenke mekhanicheskoy travmy [Causality in forensic medicine: the content, methods of detection and their significance in the expert evaluation of mechanical trauma]. Moscow: YurInfoZdrav; 2013. Russian.
5. Konovalova AN, Likhtermana LB, Potapova AA. Klinicheskoye rukovodstvo po cherepno-mozgovoy travme [Clinical guidelines for traumatic brain injury]. Moscow: Antidor, 1998;1. p.47-129.
6. Dalbayrak S, Gumustas S, Bal A, Akansel G. Early and delayed CT findings in patients with mild-to-moderate head trauma. Turk Neurosurg. 2011;21(4):591-8. [CrossRef] [PubMed]
7. Nagornov MN. Sudebno-meditsinskaya otsenka perelomov svoda cherepa pri vozdeystvii tupogo predmeta v zavisimosti ot vnutrennego stroyeniya kostnoy tkani [Forensic evaluation of fractures of the cranial vault under the influence of a blunt object, depending on the internal structure of the bone] [dissertation]. Moscow (Russia): Moscow State Medical Dental University; 2006. Russian.
8. Rodríguez Cerrillo M, Borreguero Martínez E, Jiménez de Diego L. [The risk of an organic lesion in mild craniocerebral injuries with loss of consciousness]. Rev Clin Esp. 1999 Oct;199(10):653-5. [PubMed]
9. Yavuz MS, Asirdizer M, Cetin G, Günay Balci Y, Altinkok M. The correlation between skull fractures and intracranial lesions due to traffic accidents. Am J Forensic Med Pathol.2003 Dec;24(4):339-45. [CrossRef] [PubMed]
10. Styrke J, Stalnacke BM, Sojka P, Bjornstig U. Traumatic brain injuries in a well-defined population: epidemiological aspects and severity. J Neurotrauma. 2007 Sep;24(9):1425-36. [CrossRef] [PubMed]
11. Graham DI. Neuropathology of head injury. In: Nerayan RK, Wilberger JE, Povlishock JT, editoes. New York: McGraw Hill; 1996. P.43-59.
12. Di Maio D, Di Maio VJM. Forensic Pathology. Boca Raton, London; New York; Washington: DC. CRC Press, 2001. p.147-87.
13. Hofman PAM, Nelemans P, Kemerink GJ, Wilmink JT. Value of radiological diagnosis of skull fracture in the management of mild head injury: Meta-analysis. J Neurol Neurosurg Psychiat. 2000;68(4):416-22. [PubMed]
14. Munoz-Sanchez MA, Murillo-Cabezas F, Cayuela A, Flores-Cordero JM, Rincon-Ferrari MD, Amaya-Villar R, Fornelino A. The significance of skull fracture in mild head trauma differs between children and adults. Childs Nerv Syst. 2005 Feb;21(2):128-32. [CrossRef] [PubMed]
15. Dacey RG Jr, Alves WM, Rimel RW, Winn HR, Jane JA. Neurosurgical complications after apparently minor head injury. Assessment of risk in a series of 610 patients. J Neurosurg. 1986 Aug;65(2):203-10. [CrossRef] [PubMed]
16. Ibanez J, Arikan F, Pedraza S, Sanchez E, Poca MA, Rodriguez D, Rubio E. Reliability of clinical guidelines in the detection of patients at risk following mild head injury: results of a prospective study. J Neurosurg. 2004 May;100(5):825-34. [CrossRef] [PubMed]
17. Servadei F, Ciucci G, Pagano F, Rebucci GG, Ariano M, Piazza G, Gaist G. Skull fracture as a risk factor of intracranial complications in minor head injuries: a prospective CT study in a series of 98 adult patients. J Neurol Neurosurg Psychiat. 1988 Apr;51(4):526-8. [CrossRef] [PubMed]
18. Thiruppathy SP, Muthukumar N. Mild head injury: revisited. Acta Neurochir (Wien). 2004 Oct;146(10):1075-83. [CrossRef] [PubMed]
19. Ceviker N, Baykaner K, Keskil S, Işik S, Tokyay M, Kaymaz M, Aykol S. Sella turcica fractures in a trauma series and their clinical significance. Surg Neurol. 1995 ul;44(1):28-30. [CrossRef] [PubMed]
20. Marchetti D, Filograna L, Colecchi C. Sellar fracture followed by sudden death: an autopsy case. Am J Forensic Med Pathol. 2007 Sep;28(3):223-6. [CrossRef] [PubMed]
21. Muсoz-Sбnchez MA, Murillo-Cabeze F, Cayuela-Dominguez A, Rincуn-Ferrari MD, Amaya-Villar R, Leуn-Carriуn J. Skull fracture, with or without clinical signs, in mTBI is an independent risk marker for neurosurgically relevant intracranial lesion: a cohort study. Brain Inj. 2009;23(1):39-44. [CrossRef]
22. Borczuk P. Predictors of intracranial injury in patients with mild head trauma. Ann Emerg Med. 1995 Jun;25(6):731-6. [CrossRef] [PubMed]
23. Tseng WC, Shih HM, Su YC, Chen HW, Hsiao KY, Chen IC. The association between skull bone fractures and outcomes in patients with severe traumatic brain injury. J Trauma. 2011 Dec;71(6):1611-4. [CrossRef] [PubMed]
24. Chattopadhyay S, Tripathi C. Skull fracture and haemorrhage pattern among fatal and nonfatal head injury assault victims - a critical analysis. J Inj Violence Res. 2010 Jun;2(2):99-103. [CrossRef] [PubMed]
25. Imajo T. Rapid hemorrhagic death due to basal skull fracture. Am J Forensic Med Pathol. 1988 Sep;9(3):271-2. [CrossRef] [PubMed]
26. Kruse JJ, Awasthi D. Skull-base trauma: neurosurgical perspective. J Craniomaxillofac Trauma. 1998 Summer;4(2):8-14. [PubMed]
27. Moore RS. Basal skull fracture with intracranial air. J Accid Emerg Med. 1999 Sep;16(5):384-5. [PubMed]
28. István B, Tibor V. [Incidence of blood aspiration in fatal fractures of the base of the skull]. Magy Traumatol Orthop Helyreallito Seb. 1976;19(2):118-20. Hungarian. [PubMed]
29. Skobska O.E. Kompleksna diahnostyka ta pryntsypy likuvannya khvorykh u hostromu periodi cherepno-mozkovoyi travmy z perelomom piramidy skronevoyi kistky [Complex diagnostics and treatment principles in patients with acute brain injury and temporal bone pyramid fracture] [dissertation]. Kiev (Ukraine): Romodanov Neurosurgery Institute; 2012. Ukrainian.
30. Thillainayagam K, MacMillan R, Mendelow AD, Brookes MT, Mowat W, Jennett B. How accurately are fractures of the skull diagnosed in an accident and emergency department. Injury. 1987 Sep;18(5):319-21. [CrossRef] [PubMed]
31. Turliuc D, Cucu A. Management of mild and moderate head injuries in adults. Roman Neurosurg. 2010;17(4):421-31.
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Copyright (c) 2013 Eugene Pedachenko, Vasyl Burchynskyi, Nikolay Kadzhaya, Andriy Huk, Andrey Diadechko, Dmytro Kuzmenko, Andrii Boliukh, Oleksandr Gotin, Oksana Skobska, Oleg Robak
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