Fracture of the Skull

Abstract

In patients with craniocerebral injuries the attention of the surgeon is directed for the most part toward the effects of the trauma on the structures within the cranial cavity. For this reason, little consideration is now given to a fracture of the skull except in instances in which the injury has opened the cranial cavity to potential infection, has altered the intracranial capacity by a depression of the cranial bones, has compressed a cranial nerve at its foramen of exit from the skull, or has lacerated a durai vessel with resultant epidural hemorrhage. In many instances this lesion is accompanied by clinical findings indicative of alteration in brain function, consequently the term “‘fracture of the skull” has been frequently, but incorrectly, used synonymously with craniocerebral injuries. While the brain is the most important structure in the head that may be altered anatomically and physiologically by a traumatic insult, the significance of the bony injury should not be underestimated. The principal function of the skull is to protect the brain. The cranial bones are denser and thicker over exposed parts and thinner in most cases where they are covered by muscle, as in the temporal and inferior occipital areas. The rounded shape of the vault, the resiliency of the bones, and the formation of the secondary arches make the skull moderately resistant to external trauma. The buttresses at the base (petrous part of the temporal bone and the sphenoidal ridge in particular), situated as they are between thin bone perforated with foramina, frequently cause convergence of fracture lines toward the region of the sella turcica.