SACRAMENTO, CA, July 02, 2019 — Ed Smith, a Sacramento Personal Injury Lawyer says one of the most feared injuries is that of the fractured skull.
“In some cases, the damage is minimal and self-healing,” said Smith. “In others, it can lead to internal bleeding or damage to the brain tissue. It's absolutely critical that you consult a qualified physician to make that determination.”
How Common are Skull Fractures?
Fractures in the skull are not terribly common. There are about 42,409 skull fractures seen in hospitals per year. However, some of them are cases of open head injury. This represents 1 in 6,413 people or about 0.02 percent of the population.
Smith says it would be rare to have a fracture and not need some kind of medical attention.
“A lot of the time, you would see motor vehicle accidents as the culprit in skull fractures,” said Smith. “A head injury might lead to a fractured skull. Negligence might lead to long-term effects, traumatic brain injuries, or worse, wrongful death. Immediate medical attention is critical.”
Smith adds that, because of the need to see specialists and potentially receive sophisticated treatments, compensation should be in order because of the mountain of medical bills you might be facing.
The most significant risk of a broken skull is not the fracture itself but the proximity of the skull to the brain. The fractures are sometimes associated with a brain injury that can occur because of the fracture or incidental to the fracture. It's the brain injury that causes all the morbidity and mortality of the fracture.
Causes of a Fractured Skull
Fractured skulls occur under a variety of conditions. They are commonly seen in car and motorcycle accidents, in which the passenger or driver's head strikes the roof of the car or hits the dashboard, or the victim is ejected and strikes the windshield and the ground. Other skull fractures happen when a person falls from a great distance or is involved in a sporting injury. Children can suffer a fracture during playground play.
Fractured skulls can also, unfortunately, happen in situations of child abuse and in altercations, especially those involving objects like bats and metal pipes. The skull can also be fractured as part of a penetrating injury such as a gunshot injury. In fact, any kind of head injury or head trauma can cause a fracture as well.
Symptoms of a Fractured Skull
A skull fracture is almost always associated with pain so the individual will have some kind of a headache that can be localized to the site of the fracture or generalized throughout the head. There may be local swelling and bruising at the site of the fracture. In open fractures, there is a laceration of the scalp or forehead that communicates with the fracture. This puts the person at risk for infection in the bone, or because the skull houses the brain, brain infections like meningitis or encephalitis.
In the fracture, there can be disruption of the dura covering the brain and containing the cerebrospinal fluid. When the dura is disrupted, the CSF leaks out, often leaking through the ears or nose. The finding of CSF dripping from the ears or nose is a good sign that the skull has been fractured somewhere.
The Severity of a Fractured Skull Injury
Many broken skulls result in bleeding inside the skull itself. A person can have an epidural hematoma or a subdural hematoma along with their skull fractures. These are dangerous side effects of skull fractures and often need to be evacuated, so they don't build up the pressure in the brain and cause further brain damage.
Some of the fractures do not cause hematomas but are depressed and cause trauma directly to the brain. Patients can have confusion, loss of consciousness, memory loss, or a focal neurological deficit, such as paralysis of an arm, leg, or both. Such complications can be temporary and due to brain swelling or bruising; they can also represent permanent brain injury with permanent deficits.
Risk Factors for a Fractured Skull
The key risk factors for a skull fracture include being male, engaging in high-risk behaviors like riding a motorcycle, driving recklessly, engaging in fights, and playing sports. Other risk factors include being a child and being involved in a fall.
“Those who ride motorcycles and bicycles should wear a helmet at all times because they can be thrown over the handlebars resulting in head injuries, cervical spine injuries, and skull fractures,” said Smith. “Children from high-risk homes are at risk for violence against them. Their skulls are fragile and can easily fracture. Medical professionals are trained to look for signs of child abuse.”
Diagnosis of a Broken Skull
Before any test for skull fracture is done, the doctor must do a complete physical and neurological examination to look for signs and symptoms of a fractured skull. The head is examined for areas of swelling, tenderness, or bruising. The ears and nose are examined to see if blood or cerebrospinal fluid are coming out. Bruising around the eyes can be “Raccoon's Eyes,” a sign of skull fracture, and bruising behind the ears can be a Battle Sign—evidence of a basilar skull fracture.
The doctor assesses the level of consciousness, looks for the presence of seizures or pupillary differences, and assesses the balancing abilities and level of confusion in the patient. Sometimes a Glasgow Coma Scale is done. This is an assessment of the level of consciousness of the patient and predicts the outcome of the patient's mental status later.
Should I Be Worried?
When the index of suspicion is high enough, x-ray films can be done of the skull using the anterior-posterior and lateral views. This can show areas of linearity or compound fractures of the skull or can point to a foreign body, such as a bullet. X-rays were once the only way to assess skull fractures. Now CT scans are used to evaluate areas of skull fractures along with areas of brain damage or bleeding inside the brain from the fracture.
If bleeding is found, its location and size can be identified, and the individual can have a burr hole placed in the skull to drain the brain from any hematoma found. The CT scan is especially useful when it comes to looking at bones and finding areas of bleeding or bruising on the brain.
Treatment of a Fractured Skull
The treatment of a broken skull depends on the type and severity of the fracture. Fortunately, many fractures of the skull need no treatment because the bones splint themselves, the fracture is not displaced, and the bone will heal itself over time. Most of the treatment of skull fractures involves pain control, the promotion of healing, and the prevention of any complications. The biggest complication to be monitored for is a traumatic brain injury, which can happen with any type of skull fracture.
In a linear fracture, treatment is rarely necessary. It shows up as a crack in the skull bone and is rarely out of place. Pain control is the best possible treatment if there is no evidence of bleeding behind the fracture. The patient can be sent home and is cautioned against doing anything that might make the head trauma worse. If there are no complications, the patient will generally heal without difficulty.
Going the Extra Mile
If, on the other hand, the bones are out of alignment, surgery is necessary to remove fragments or use plates to hold them together. If the dura has not been penetrated and there is no brain damage, the outlook is good. If the dura is punctured, an infection can happen. Fragments that impact the brain can cause brain damage.
In a depressed skull fracture, one or more fragment is depressed and is pushing on the brain. The treatment depends on how deep the depression is. It also depends on whether or not there is an open wound overlying the fracture. If the depression is less than the thickness of the skull and the fracture is closed without overlying laceration, the wound generally heals well.
If the depression is more profound and if it has an open wound, there is often a lot of brain damage, and it is necessary to do surgery to remove fragments pressing on the brain and to treat areas of bleeding on the brain. In many cases, depressed fractures lead to mild, moderate, or severe brain damage and permanent disability.
Complications of a Fractured Skull
Many fractures heal without intervention and without any brain injury or disability. These usually are the linear skull fractures or comminuted fractures that do not have any bones out of place. If the cause of the fracture also injures the dura and cerebrospinal fluid spills out, bacteria can get in and cause meningitis or encephalitis. These can cause permanent disability and require antibiotics to get better.
The biggest complication of a fractured skull happens when there is bleeding inside the fracture or when fragments are depressed and piercing the brain. This is where brain damage occurs along with permanent disability from portions of the brain that do not regenerate after an injury.
Recovery After a Fractured Skull
The recovery process following a fractured skull could take weeks or even months depending on the severity of the injury. Pain management will be important and individuals might require physical or occupational therapy to help them return to school or work. In addition, one of the major challenges of a fractured skull is the possibility of associated injuries.
While any of these could require surgical repair, a TBI is the most serious injury that could accompany a skull fracture. A serious skull fracture could cause a penetrating injury of the brain via the bone fragments from the skull. When this happens, individuals could suffer a brain bleed that might require surgical repair.
The recovery process following a skull fracture associated with a TBI could require extensive rehab to help individuals regain lost motor or sensory function. Some people might never achieve a full recovery. Those who have suffered a TBI also have a higher chance of developing debilitating mental health disorders which might require long-term care.
Edward A. Smith, the founder of AutoAccident.com, has been awarded a 'superb' or 'perfect' rating of 10.0 by Avvo. This largely peer-reviewed rating reflects his unrelenting commitment and personal dedication to his clients since 1982. Mr. Smith's legal practice, the Law Offices of Edward A. Smith, focuses exclusively on personal injury and wrongful death claims.
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