Skull fracture
Basilar skull fracture; Depressed skull fracture; Linear skull fractureA skull fracture is a fracture or break in the skull (cranial) bones.
Fracture
If more pressure is put on a bone than it can stand, it will split or break. A break of any size is called a fracture. If the broken bone punctures...
Read Article Now Book Mark ArticleConsiderations
Skull fractures may occur with head injuries. The skull provides good protection for the brain. However, a severe impact or blow can cause the skull to break. It may be accompanied by a concussion or other injury to the brain.
Head injuries
A head injury is any trauma to the scalp, skull, or brain. Head injury can be either closed or open (penetrating). A closed head injury means you rec...
Read Article Now Book Mark ArticleConcussion
A traumatic brain injury (TBI) can occur when the head hits an object, or a moving object strikes the head. There are three types of TBI:Mild TBI, a...
Read Article Now Book Mark ArticleThe brain can be affected directly by damage to the nervous system tissue and bleeding. The brain can also be affected by bleeding under the skull. This can compress the underlying brain tissue.
A simple fracture is a break in the bone without damage to the skin.
A linear skull fracture is a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone.
A depressed skull fracture is a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brain.
A compound fracture involves a break in, or loss of, skin and splintering of the bone.
Causes
Causes of skull fracture can include:
- Head trauma
- Falls, automobile accidents, physical assault, and sports
Symptoms
Symptoms may include:
- Bleeding from wound, ears, nose, or around eyes
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Bruising behind the ears or under the eyes
Bruising
A bruise is an area of skin discoloration. A bruise occurs when small blood vessels break and leak their contents into the soft tissue beneath the s...
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Sizes unequal
Anisocoria is unequal pupil size. The pupil is the black part in the center of the eye. It gets larger in dim light and smaller in bright light....
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Confusion
Confusion
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
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Seizures
A seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...
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- Drainage of clear or bloody fluid from ears or nose
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Drowsiness
Drowsiness
Drowsiness refers to feeling more sleepy than normal during the day. People who are drowsy may fall asleep when they do not want to or at times whic...
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Headache
Headache
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...
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Nausea and vomiting
Nausea and vomiting
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up forces the contents of the stomach up t...
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Restlessness, irritability
Restlessness
Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.
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Slurred speech
Slurred speech
Dysarthria is a condition in which you have difficulty saying words because of problems with the muscles that help you talk.
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Stiff neck
Stiff neck
Neck pain is discomfort in any of the structures in the neck. These include the muscles, nerves, bones (vertebrae), joints, and the discs between th...
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Swelling
Swelling
Swelling is the enlargement of organs, skin, or other body parts. It is caused by a buildup of fluid in the tissues. The extra fluid can lead to a ...
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In some cases, the only symptom may be a bump on the head. A bump or bruise may take up to 24 hours to develop.
First Aid
Take the following steps if you think someone has a skull fracture:
- Check the airways, breathing, and circulation. If necessary, begin rescue breathing and CPR.
- Avoid moving the person (unless absolutely necessary) until medical help arrives. Have someone call 911 or the local emergency number for medical assistance.
- If the person must be moved, take care to stabilize the head and neck. Place your hands on both sides of the head and under the shoulders. Do not allow the head to bend forward or backward, or to twist or turn.
- Carefully check the site of injury, but do not probe in or around the site with a foreign object. It can be hard to know if the skull is fractured or depressed (dented in) at the site of injury.
- If there is bleeding, apply firm pressure with a clean cloth over a broad area to control blood loss, but do not apply pressure directly onto a suspected skull fracture.
- If blood soaks through, do not remove the original cloth. Instead, apply more cloths on top, and continue to apply pressure.
- If the person is vomiting, stabilize the head and neck, and carefully turn the victim to the side to prevent choking on vomit.
- If the person is conscious and experiencing any of the previously listed symptoms, transport to the nearest emergency medical facility (even if the person does not think medical help is needed).
Do Not
Follow these precautions:
- Do not move the person unless absolutely necessary. Head injuries may be associated with spinal injuries.
- Do not remove protruding objects.
- Do not allow the person to continue with physical activities.
- Do not forget to watch the person closely until medical help arrives.
- Do not give the person any medicines before talking to a health care provider.
- Do not leave the person alone, even if there are no obvious problems.
When to Contact a Medical Professional
The provider will perform a physical exam. The person's nervous system will be checked. There may be changes in the person's pupil size, thinking ability, coordination, and reflexes.
Get medical help right away if:
- There are problems with breathing or circulation.
- Direct pressure does not stop bleeding from the nose, ears, or wound.
- There is drainage of clear fluid from the nose or ears.
- There is facial swelling, bleeding, or bruising.
- There is an object protruding from the skull.
- The person is unconscious, is experiencing convulsions, has multiple injuries, appears to be in any distress, or cannot think clearly.
Tests that may be done include:
- Blood and urine tests
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Brain wave test [electroencephalogram (EEG)] may be needed if seizures are present
Brain wave test
An electroencephalogram (EEG) is a test to measure the electrical activity of the brain.
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Head CT scan
Head CT scan
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
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MRI of the brain
MRI of the brain
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
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X-rays
X-rays
A skull x-ray is a picture of the bones surrounding the brain, including the facial bones, the nose, and the sinuses.
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Prevention
Not all head injuries can be prevented. The following simple steps can help keep you and your child safe:
Simple steps
Although no child is injury proof, parents can take simple steps to keep their children from getting head injuries.
Read Article Now Book Mark Article- Always use safety equipment during activities that could cause a head injury. These include seat belts, bicycle or motorcycle helmets, and hard hats.
- Learn and follow bicycle safety recommendations.
- Do not drink and drive. Do not allow yourself to be driven by someone who may have been drinking alcohol or is otherwise impaired.
References
Bazarian JJ. Traumatic brain injury and spinal cord injury. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 368.
Papa L, Goldberg SA. Head trauma. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 33.
Roskind CG, Pryor HI, Klein BL. Acute care of multiple trauma. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA. Elsevier; 2020:chap 82.
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Skull of an adult - illustration
This picture shows a normal skull of an adult.
Skull of an adult
illustration
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Skull fracture - illustration
Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull and may be accompanied by injury to the brain. Some of the different types of skull fracture include simple -- a break in the bone without damage to the skin; linear or hairline -- a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone; depressed -- a break in a cranial bone (or crushed portion of skull) with depression of the bone in toward the brain; or a compound -- a break in or loss of skin and splintering of the bone. Along with the fracture, brain injury, such as subdural hematoma (bleeding) may occur.
Skull fracture
illustration
-
Skull fracture - illustration
Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull and may be accompanied by injury to the brain. Some of the different types of skull fracture include simple -- a break in the bone without damage to the skin; linear or hairline -- a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone; depressed -- a break in a cranial bone (or crushed portion of skull) with depression of the bone in toward the brain; or a compound -- a break in or loss of skin and splintering of the bone. Along with the fracture, brain injury, such as subdural hematoma (bleeding) may occur.
Skull fracture
illustration
-
Battle's sign - behind the ear - illustration
Skull fractures are common in children and result from accidents (the majority are automobile or auto/bike accidents) or abuse. Battle's sign is seen several days following a basilar skull fracture. There may have been bloody drainage from the ear immediately after the fracture occurred.
Battle's sign - behind the ear
illustration
-
Infant skull fracture - illustration
Skull fractures may occur with head injuries. Although the skull is both tough and resilient and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull and may be accompanied by injury to the brain.
Infant skull fracture
illustration
-
Skull of an adult - illustration
This picture shows a normal skull of an adult.
Skull of an adult
illustration
-
Skull fracture - illustration
Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull and may be accompanied by injury to the brain. Some of the different types of skull fracture include simple -- a break in the bone without damage to the skin; linear or hairline -- a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone; depressed -- a break in a cranial bone (or crushed portion of skull) with depression of the bone in toward the brain; or a compound -- a break in or loss of skin and splintering of the bone. Along with the fracture, brain injury, such as subdural hematoma (bleeding) may occur.
Skull fracture
illustration
-
Skull fracture - illustration
Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull and may be accompanied by injury to the brain. Some of the different types of skull fracture include simple -- a break in the bone without damage to the skin; linear or hairline -- a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone; depressed -- a break in a cranial bone (or crushed portion of skull) with depression of the bone in toward the brain; or a compound -- a break in or loss of skin and splintering of the bone. Along with the fracture, brain injury, such as subdural hematoma (bleeding) may occur.
Skull fracture
illustration
-
Battle's sign - behind the ear - illustration
Skull fractures are common in children and result from accidents (the majority are automobile or auto/bike accidents) or abuse. Battle's sign is seen several days following a basilar skull fracture. There may have been bloody drainage from the ear immediately after the fracture occurred.
Battle's sign - behind the ear
illustration
-
Infant skull fracture - illustration
Skull fractures may occur with head injuries. Although the skull is both tough and resilient and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull and may be accompanied by injury to the brain.
Infant skull fracture
illustration
Review Date: 11/2/2023
Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.