Depressed Fractures of Skull: An Institutional Series of 453 Patients and Brief Review of Literature

BACKGROUND: There has been a substantial increase in the number of cases with head injuries in the past two decades which has simultaneously led to increase in the annual incidence of depressed fractures of skull. Most of these skull fractures are associated with considerable morbidity and mortality of patients and an unavoidable financial burden on the family members. However, many changes have been undertaken directed toward improved management of patients with head injuries and skull fractures in the past 20 years. OBJECTIVE: To study and compare the patterns of occurrence of the depressed fractures of skull and examine the factors which may influence the surgical outcome of patients with reference to similar case series from the past literature. PATIENTS AND METHODS: We reviewed patient records of 453 patients admitted with depressed skull fractures in Department of Neurosurgery, Rajendra Institute of Medical Sciences, Ranchi, India, during the period of March 2004 through July 2009. RESULTS: The incidence of depressed skull fracture was highest (56%) in the age group of 16–45 years. There was a predominance of male cases over females with a ratio of 7:1. The most common mode of injury was noted to be alleged assault (36%) and the parietal region (34%) being the most common site. Most cases had mild injury (62%) with Glasgow Coma Scale score of 13–15. The percentage of pure depressed fractures was 57% and the rest 42% were associated with intracranial lesion, of which the most common was contusion (25%). Superficial wound infection was observed in 38% of the patients. Of all the 453 patients, 91% were operated and most of them were operated within 24 h with overall mortality rate of 17%. CONCLUSIONS: Our study revealed the increased incidence of mortality in the age group of 16–45 years, which can guide our focus of management on them with strategic planning at individual as well as community level. Primary surgical repair of depressed skull fractures is safe, feasible, and associated with good outcomes. There was no significant association between tear in dura and an increase in the complications and, also, no substantial data to support the use of prophylactic antibiotics in patients to reduce chances of infection with it.