Depressed skull fracture


Treatment of depressed skull fractures

Before hospitalization, it is important to stop bleeding by applying a pressure bandage so as not to dislodge the fragments. Depressed fracture is treated surgically. Contraindications to intervention – shock, fat embolism, heavy blood loss. Conservative treatment is possible with a closed fracture, if there is no compression of the meninges.

The basic principles that are adhered to during the treatment:

  • Mobilization of fragments by a spherical milling cutter of small diameter that preserves the area of ​​the intact bone.

  • Free bone fragments fixed by the outer bone plate are extracted after the plate is bent.

  • Multi-lobe impressions operate, using wide trepanation. This allows you to quickly stop bleeding.

  • If you can not conduct a CT scan, dissecting the medulla to study the state of the brain space. The method is inadmissible if the wound is dirty.

  • If the hard shell is damaged, a revision of the brain space is performed. The membrane is made of polytetrafluoroethylene with a thickness of 3 mm.

  • The most difficult is a fracture when acute fragments invade the cavity of the skull, damaging large vessels. Here you need access to the interhemispheric cleft, suturing the hard shell, and inserting a muscle strip that can be replaced with a TachoComb.

  • For any kind of depressed fracture, the final stage is the restoration of the skull surface. Optimal plastic is considered a preserved fragment, combining it with a common cover by gluing. Strengthening of bone is made by titanium plates. If bone fragments are extracted, further work with them is possible after thorough disinfection. When small fragments that have lost contact with the periosteum, contamination of the wound or brain edema, reconstruction is dangerous. In this case, a dural prosthesis is used to seal the wound.


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