Skull Fracture: Symptoms, Types, Causes and Treatment

Skull fractures are a significant medical concern that can range from mild injuries to life-threatening emergencies. They occur when a forceful impact causes a break in one or more bones of the skull. Understanding the symptoms, types, causes, and treatments of skull fractures is crucial for rapid diagnosis and effective management. This article brings together current evidence and clinical insights to provide a comprehensive overview of skull fractures.

Symptoms of Skull Fracture

Recognizing the symptoms of a skull fracture is vital for early intervention and prevention of complications. While some fractures may present with obvious signs, others can be subtle, requiring careful assessment. Symptoms can vary depending on the type and location of the fracture, the age of the patient, and the severity of associated injuries.

Symptom	Description	Associated Findings	Source(s)
Loss of consciousness	Temporary or prolonged unconsciousness	May indicate intracranial injury	1 10
Focal neurological deficits	Weakness, numbness, or speech issues	Linked to brain involvement	1 2 4 8
Scalp swelling/mass	Raised, sunken, or pulsatile mass	Often seen in growing fractures	2 8
Seizures	Unprovoked convulsions	Suggests cortical irritation	2 4 13
CSF leak (liquorrhea)	Clear fluid from nose or ear	Indicates skull base fracture	5 16 18
Headache	Localized or diffuse head pain	Non-specific, not always predictive	1
Vomiting	Nausea with emesis	Not strongly predictive	1
Dislocated bone fragments	Visible or palpable deformity	More common in depressed fractures	5 13

Table 1: Key Symptoms

Understanding the Symptoms

The symptoms of skull fracture can be grouped based on their clinical significance and urgency.

Neurological Symptoms

• Loss of consciousness (LOC) is a red flag, especially if prolonged. LOC is significantly correlated with intracranial hemorrhage in patients with skull fractures 1.
• Focal neurological deficits such as weakness (hemiparesis), speech impairment (dysphasia), or sensory loss point toward possible brain injury or compression. These are more frequent in growing skull fractures and severe trauma 1 2 4 8.
• Seizures may occur due to irritation or damage to the brain cortex, commonly observed in cases with underlying brain injury or growing skull fractures 2 4 13.

Local Physical Signs

• Scalp swelling or fluctuating mass is often seen in children with growing skull fractures, sometimes appearing as a sunken area or pulsatile mass over the fracture site 2 8.
• Visible bony deformity or displacement is typical in depressed skull fractures and may be palpable or seen on imaging 5 13.
• Cerebrospinal fluid (CSF) leak, presenting as clear fluid from the nose (rhinorrhea) or ear (otorrhea), is a hallmark of skull base fractures with dural laceration 5 16 18.

Other Symptoms

• Headache and vomiting are common but not necessarily predictive of significant skull fracture or intracranial pathology 1.
• Signs of infection (e.g., fever, meningitis) may develop if the fracture is open and complicated by CSF leak or delayed treatment 16.

Types of Skull Fracture

Skull fractures come in various forms, each with unique implications for prognosis and treatment. Understanding these types is essential for clinicians to determine the best course of action.

Type	Description	Distinguishing Feature	Source(s)
Linear	Simple break, no bone displacement	Most common, often from falls	10 11
Depressed	Bone pushed inward	May compress brain tissue	13 17
Comminuted	Bone broken into multiple pieces	Complex, higher risk of injury	10
Basilar	Involves base of skull	Associated with CSF leak, nerve injury	5 10 16 18
Growing	Widening fracture with brain herniation	Common in young children, scalp mass	2 6 8
Diastatic	Fracture along suture lines	Often in infants, may expand	2
Occipital condyle	Fracture at base of skull (occiput)	Can impair skull mobility	3

Table 2: Main Types of Skull Fracture

Detailed Breakdown of Skull Fracture Types

Linear Fractures

• Definition: The most frequent type, especially in accidents and falls 10 11.
• Features: A single, clean break without bone displacement. They rarely require surgery unless associated with other injuries.

Depressed Fractures

• Definition: Skull bone is sunken from the impact 13 17.
• Risks: May press on the brain, increasing risk for neurological damage, infection, or seizures.
• Management: Surgical elevation is often considered for severe depressions, especially if the depression exceeds the skull’s thickness or if dural tears are present 13 17.

Comminuted Fractures

• Definition: Bone is shattered into several pieces 10.
• Complexity: Increased risk of brain injury, especially with open wounds.

Basilar Skull Fractures

• Definition: Affect the skull base (near the eyes, ears, or nose) 5 10 16.
• Symptoms: May present with CSF leak, cranial nerve deficits, or bruising around the eyes/ears.
• Complications: High risk for infection (meningitis), hearing loss, or facial paralysis 16 18.

Growing Skull Fractures (Leptomeningeal Cyst)

• Definition: Rare, mainly in children under 3 years; fracture widens over time due to brain or CSF herniation 2 6 8.
• Symptoms: Scalp swelling, neurological deficits, seizures.
• Imaging: CT/MRI shows widening and possible brain tissue herniation.

Diastatic Fractures

• Definition: Occur along skull sutures, mostly in infants/young children 2.
• Concern: Can widen and lead to growing fractures if left untreated.

Occipital Condyle Fractures

• Definition: Affect the joint connecting skull to spine 3.
• Presentation: May cause neck pain and impaired skull mobility.

Causes of Skull Fracture

Understanding what causes skull fractures is essential to both prevention and treatment. Various mechanisms can result in different patterns of fracture, affected by age, activity, and trauma type.

Cause	Typical Scenario	High-Risk Groups	Source(s)
Falls	Accidental drop from height, slips	Children, elderly	2 10 11
Road traffic accidents (RTA)	Vehicle collisions, pedestrian injuries	All ages, high-energy trauma	10 11 12
Assault	Blunt force from violence	Adults, adolescents	10 13
Sports injuries	Contact sports, recreation	Children, young adults	11
Falling objects	Heavy object strikes head	Occupational hazards	13

Table 3: Common Causes of Skull Fracture

Mechanisms and Risk Factors

Falls

• Leading cause in children and elderly due to weaker bones or developmental stages 2 11.
• Often result in linear fractures, but can cause basilar or growing fractures in the very young 2 8 10.

Road Traffic Accidents (RTAs)

• Major cause in all age groups; involve high-energy impacts 10 11 12.
• Frequently cause multiple, complex fractures (comminuted, basilar) and concurrent injuries.

Assaults

• Second most common in many adult populations 10 13.
• Usually result in depressed or comminuted fractures, especially with blunt objects.

Sports and Recreational Injuries

• Less common but significant in children and young adults 11.
• May cause various fracture types depending on force and equipment used.

Falling Objects

• Rare but can cause severe depressed fractures, particularly in occupational settings 13.

Special Pediatric Considerations

• Growing skull fractures develop from initial trauma (often falls) when the fracture involves a dural tear, leading to progressive widening and brain herniation 2 6 8.
• Diastatic fractures are unique to infants/young children due to open sutures 2.

Treatment of Skull Fracture

Treatment strategies for skull fractures depend on the type, severity, patient’s age, and presence of complications. Early and appropriate intervention can prevent long-term disability and life-threatening outcomes.

Treatment	Indication	Key Points	Source(s)
Conservative	Linear/simple fractures, no complications	Observation, pain control	13 15 17
Surgical	Depressed/comminuted, open, or complicated fractures	Elevation, debridement, repair	13 15 17 18
Antibiotics	Open/compound fractures, CSF leak	Prevent infection	15 16
Dural repair/cranioplasty	Growing or basilar fractures with CSF leak	Prevent herniation/infection	4 6 8 16 18
Observation/follow-up	All pediatric fractures, especially <3 years	Monitor for complications	2 8 17

Table 4: Management Approaches

Approaches to Skull Fracture Treatment

Conservative Management

• Linear fractures without neurological symptoms or open wounds are typically monitored with observation, bed rest, and pain management 13 15 17.
• Simple depressed fractures in children may not require surgery if there is no dural penetration and cosmetic appearance is acceptable 17.

Surgical Intervention

• Depressed/comminuted fractures with bone displacement, dural tears, open wounds, or neurological deficits often require surgery. This can include:
  • Elevation of bone fragments
  • Debridement of contaminated tissue
  • Repair of the dura mater
  • Evacuation of hematomas 13 15 17 18
• Compound fractures (open to the environment) have a higher infection risk and may need urgent intervention 13 15.

Infection Prevention

• Antibiotics are essential in open (compound) fractures and cases with CSF leak to prevent meningitis and brain abscesses 15 16.
• Early closure of scalp wounds helps reduce infection risk 15.

Special Considerations

• Growing skull fractures require early surgical repair of the dura and cranioplasty to prevent brain herniation and secondary brain damage. Delayed treatment may lead to irreversible neurological deficits or epilepsy 4 6 8.
• Basilar skull fractures with persistent CSF leak may need surgical closure of the fistula, often with vascularized tissue flaps to ensure a watertight seal and prevent infection 16 18.
• Close observation and follow-up are crucial in children, especially those under 3 years with diastatic or growing fractures, to detect delayed complications 2 8 17.

Emerging and Multidisciplinary Techniques

• Advanced surgical techniques such as multilayer closure with vascularized flaps are used in complex skull base fractures to minimize CSF leaks and improve long-term outcomes 18.
• Imaging (CT/MRI) is key for diagnosis, surgical planning, and monitoring of healing or complications 2 6 8 18.

Conclusion

Skull fractures encompass a wide spectrum of injuries, each demanding careful evaluation and tailored management. Early recognition of symptoms, understanding the fracture type, identifying the cause, and applying appropriate treatment strategies are fundamental to achieving the best possible outcomes.

Key Takeaways:

• Skull fractures can present with neurological symptoms, scalp deformities, or CSF leaks; some may be subtle and require high suspicion.
• Types include linear, depressed, comminuted, basilar, growing, diastatic, and rare forms like occipital condyle fractures—each with specific clinical implications.
• Leading causes are falls, road traffic accidents, and assaults, with special patterns seen in children and certain high-risk activities.
• Treatment ranges from conservative observation to complex surgical repair, guided by the nature of the fracture and presence of complications.
• Early intervention, infection prevention, and close follow-up—especially in children—are critical for reducing morbidity and mortality.

Being aware of the diverse presentations and management of skull fractures can make a tangible difference in patient care and recovery.