Consultation with the Specialist
Skull Fractures in Infancy and Childhood
Charles C. Duncan MD1
1 Departments of Surgery/Neurosurgery and Pediatrics, Yale University School of Medicine, New Haven, CT.
Skull fractures may be divided into the three following general categories: linear fracture of the cranial vault, depressed fractures, and basilar skull fractures. Neurologic care of infants and children should be based on neurologic condition rather than the presence or absence of a fracture. In other words, decisions regarding hospitalization should be based on the history and examination rather than the presence or absence, for example, of a linear calavarial vault fracture.
Linear Fracture of the Cranial Vault
Linear calavarial vault fractures in infants may be somewhat less common than in older children, but they occur with similar force because of the flexibility of the thinner bone. When fractures do occur, a sufficiently large loss of blood due to significant subgaleal or intracranial bleeding may cause shock. Hence, hematocrits need to be measured frequently in minor head injuries in infants who have skull fractures; other assessments of blood volume may need to be made as indicated clinically.
Depressed Fractures
The flexibility of the skull also leads to a higher incidence of depressed fractures or so called "ping pong" fractures, where the normal convex contour of the cranial vault is reversed in the presence of minimal or no break. Some ping pong fractures may elevate spontaneously, but the majority will remain depressed unless elevated surgically.
