Closed injuries of the skull and brain. Skull injuries

Among the most dangerous injuries is an open skull fracture. Loss of blood, damage to parts of the brain, pinched or ruptured nerves lead not only to loss of vision, hearing, but also to a person’s life itself. Preventing death entails complex treatment, long rehabilitation.

Features of damage

According to statistics, every tenth injury identified by x-ray is recognized as a fracture of the skull bones. The majority of patients are middle-aged men who got into drunken conflicts with a criminal nature.

Individuals are at high risk of serious injury if they:

• car accident - the impact of the collision often damages top part bodies;
• extreme sports;
• falling, jumping from a great height by accident or for the purpose of suicide - a skull fracture will be combined with other injuries;
• accidents associated with the destruction of the skull from the fall of massive objects.

An open fracture of the bones at the base of the skull occurs after applying force to the base of the nose, lower jaw. But statistics reflect numerous cases of damage to the vault, extended by a fracture line to the cranial base (from 30% to 60%).

A split occurs in the occipital, temporal, sphenoid, ethmoid bones, or several at once.

Some cases of cranial fractures are the result of neglect of small children, which has led to children falling and hitting their heads. The bone structure of a small child is not sufficiently formed, so the risk of damage is higher. Cranial cracks most often extend from the injured vault.

In almost half of the cases, compression and brain damage result in death. The complex structure of the skull is characterized by a large number of vessels, bones, nerves, and air structures. Violation of integrity occurs as a result of damage of a direct or indirect nature:

• direct fracture - a fracture in the impact contact zone;
• indirect fracture - the influence of force from other areas, for example, from the spine.

Open traumatic brain injuries are defined as cracks and fractures without bone displacement. Subsequent recovery is associated with favorable prognoses. Penetrating type injuries with bleeding, spinal brain fluid through the nose, the auditory openings pose a great threat to life.

The reason lies in the displacement of bone fragments, ruptures of the meninges - as a result, infection of the internal structures occurs.

Classification

The basis for determining the nature of the injury is the location of the injury, the characteristics of the fracture, and the severity of the injury. The International Classification of Diseases (ICD-10) provides classes of diseases and lists of types of cranial fractures.

Damage to the calvarium

Formed after impact hairy area heads. Damage to the internal plates of the bone manifests itself as wounds and hematomas. Persons under narcotic or alcohol intoxication are more susceptible to this type of injury.

By location, lesions of various structures are distinguished:

• facial area;
• skull base;
• zones of brain content.

Dentists, otolaryngologists, and maxillofacial surgeons work on damage to the facial area. Neurosurgeons deal with injuries to the base of the skull that involve the brain.

Damage to the base of the skull is the most dangerous wound with a survival rate of about 50%.

The nature of the fault determines:

1. Depressed, or impression, fracture. The fragments enter the skull, damaging the meninges, branches of blood vessels, and brain matter. Destructive processes and survival prognoses are built depending on the depth of the lesion. Such cranial injuries in young children are less dangerous due to the elastic bone structure.
2. . The size of the fault may vary, but there is no threat to life. If there is no bone displacement, damage to the meningeal arteries and, accordingly, the formation of epidural hemorrhages is possible.
3. Perforate fracture. Appears after gunshot wounds and forms through holes. The entry of a bullet through the bones of the skull into the brain is associated with destruction incompatible with life.
4. Comminuted fracture. The mobility of fragments in the damaged area disrupts the meninges and causes intracerebral hematomas. Clinical symptoms are close to those of a depressed lesion. High risk lethal outcome.

The fracture is characterized by:

• independence of manifestations;
• the role of “accompaniment” of cranial vault injury.

The clinical picture is formed by fractures of the cranial fossae: anterior, middle or posterior.

Pathogenesis

The mechanism of a cranial fracture is associated with a rupture of the dura mater of the brain. Cavity formation with external environment leads to nasal and ear liquorrhea (leakage of cerebrospinal fluid) mixed with blood. Disorders of nutrition and metabolism of the brain, the penetration of infectious agents into the contents of the skull create a great threat to human life.

The occurrence of hemorrhage in the periorbital tissue (raccoon eyes), subcutaneous emphysema, post-traumatic pneumocephalus is associated with damage to the ethmoid bone plate brain section, fracture of the bones of the anterior fossa of the skull.

Symptoms

The manifestations of symptoms are related to the etymology of the wound.

Are common negative states appear:

• in disturbances of consciousness, from temporary loss to falling into a coma;
• in changes in sensitivity, paresis and paralysis;
• in swelling of the meninges;
• in severe pain syndromes, nausea, vomiting;
• in respiratory and circulatory disorders.

The clinical picture is determined by the location and nature of bone destruction.

Damage to the anterior fossa of the skull

The formation of bruises continues up to three days after the injury. Subcutaneous emphysema appears as a result of damage to the airways and destruction of the geometry of the cellular bone.

Characteristic symptoms:

• nose bleed;
• ear or nasal leakage of cerebrospinal fluid;
• dark circles around the eyes.

Hemorrhage into the tissue eyeballs gives additional symptom exophthalmos (bulging eyes). The appearance of bruises around the eyes is a sign of a fracture of the anterior fossa. There are disturbances in coordination in space of all senses: hearing, smell, vision.

Damage to the middle fossa of the skull

A common injury among skull lesions, up to 50% of cases. Damage to the lateral parts of the skull affects the inner and, to a lesser extent, the middle ear. The facial nerve is affected.

The following symptoms occur:

• hearing loss or complete deafness;
• leakage of cerebrospinal fluid through the ears;
• ear bleeding;
• imbalance;
• dysfunction facial nerve;
• disappearance of the sense of taste.

There are transverse, oblique, and longitudinal fractures. Their distribution includes bone thinning and holes. Impacts to the occipital area cause a fracture of the temporal bone pyramid.

Damage to the posterior fossa of the skull

A dangerous condition with impaired respiratory and cardiovascular functions.

Symptoms of damage:

• bruises in the area behind the ears, in place mastoid process;
• simultaneous damage to the abducens nerves and others responsible for hearing, vision, and innervation of facial expressions.

Possible manifestation bulbar syndrome as a result of damage to the cranial nerves: paralysis, paresis of the larynx, palate, tongue.

Diagnostics

Analysis of symptoms and manifestations of cerebral disorders forms the basis of the primary diagnosis of the victim

The following are subject to assessment:

• muscle tone;
• reflexes;
• types of sensitivity;
• pupil reactions;
• uniform grin of teeth;
• midline position of the tongue;
• character of pulse and pressure, etc.

Additional hardware studies are carried out: radiography in two projections, MRI, computed tomography, echoencephalography.

In case of intoxication, a serious condition of the patient, with disruption of vital systems, the diagnosis is made to the patient on the basis of clinical data.

After stabilization of the condition, the necessary radiography and other studies are carried out to clarify the diagnosis and determine therapeutic measures.

Features of cranial injuries in children

The manifestations of craniocerebral lesions in young children differ significantly from the symptoms characteristic of adults. Diagnosing injuries is more difficult. The consequences affect the development of the child’s body.

On the one hand, the ossification of the child’s skull is not complete, the tissues are plastic, the joints are loose. Hemorrhages and splinter fractures occur much less frequently than in adults. Nerve centers and the blood circulation of the brain are not completely differentiated, which ensures the child’s compensatory capabilities.

On the other hand, damage to immature brain structures leads to developmental disorders. Among the consequences are epilepsy, hearing and vision damage, delay mental development and etc.

The most common causes of traumatic brain injury are:

• newborns falling from the changing table due to adult oversight;
• babies fall out of cribs, high chairs, strollers, and windows.

The child is more often hit by the parietal region of the head, much less often by the frontal or occipital region. Loss of consciousness in a child is almost never observed, unlike in schoolchildren and adults.

The main symptoms of injury are screaming, restlessness, refusal to eat, and vomiting. Temporary improvement may cause misconceptions about recovery. But the child’s condition can change dramatically: from drowsiness to the comatose stage.

Open craniocerebral injuries are often identified as cracks. Swelling appears in the area of ​​the linear fracture. Timely consultation with a doctor reduces the risks of complications and severe consequences.

First aid

The victim needs emergency assistance after receiving a head injury. While waiting for paramedics, the wounded person, if he is conscious, can be placed on his back. In case of unconsciousness - on one side with the body supported on a cushion of things and clothing. Remove all items of clothing that restrict movement: belts, waistbands. Unfasten the buttons in the neck and chest area.

The head must be turned slightly and held still so that you cannot choke on the vomit. Transport immobilization made from scrap materials.

Bleeding is stopped with a bandage gently pressed to the wound. The development of swelling at the site of injury can be reduced by applying ice wrapped in a cloth or a bottle of cold water. You should check the cleanliness of the respiratory tract, eliminate mucus and blood clots to avoid asphyxia, and prevent tongue retraction.

Medications are administered only by emergency physicians. If the called team is delayed, it is allowed to take an anesthetic provided that the swallowing reflex and consciousness of the victim are preserved.

Treatment

The nature of medical care depends on the severity of the fracture and the patient’s health characteristics. After the diagnosis is established, conservative treatment or surgery is prescribed, followed by subsequent therapy.

Neurosurgeons remove fragments, blood clots, necrotic tissue, eliminate vascular damage, and treat wounds. Surgeries are necessary in case of purulent inflammation in areas of damage.

The following drugs are used in therapeutic treatment:

• anti-inflammatory drugs;
• antibiotics;
• means for activating cerebral circulation;
• nootropics;
• diuretics;
• vasotropes.

Linear fractures can be successfully treated without aggravating consequences. A fracture of the base of the skull leads to disability if doctors manage to save the patient’s life.

Treatment for patients with skull injuries is long-term. Bed rest, wearing an adhesive tile bandage, rehabilitation procedures. The outcome largely depends on the nature of the injury and the general condition of the victim.

Statistics show that most dangerous fractures are the result of a person’s frivolous attitude towards health and life. A hospital bed is not the most joyful place, so you need to protect yourself and your loved ones from dangerous injuries.

The human skull is a collection of twenty-three different bones, which are connected together and perform protective function brain and sensory organs, and are also their repository.

A fracture of the skull bones is a rather dangerous injury, in which there is a huge percentage of mortality or disability for the victim. Subsequent treatment and its effectiveness largely depend on providing first aid to the victim and hospitalizing him in a medical facility.

A skull fracture in a child occurs in 30% of all cases of this injury, and it is at a young age that the most big risk death, prolonged coma or subsequent disability.

Classification

There are closed (without damage to nearby soft tissues) and open skull fractures (with damage to the skin).

Injuries are also distinguished by their traumatic nature:

• A depressed skull fracture is an indentation of bones into the area of ​​the skull due to force. Often this type of injury poses a risk to blood vessels, the meninges, and brain fluid. In most cases, damage of this type is accompanied by profuse hemorrhage;
• perforated skull fractures - mainly such injuries occur when gunshot wound in the head, and their outcome is the immediate death of a person;
• fractures of the skull bones of the comminuted type – characteristic features This damage is caused by bone fragments broken off as a result of trauma. Present Great chance that broken bone fragments can damage the brain matter. The outcome of such an injury is equivalent to the outcome of a depressed fracture, but most often the result is disastrous;
• Linear fractures of the human skull are the safest injury that occurs without displacement of bone fragments. During of this type injury there is a high survival rate for the victim.

Causes

Skull fractures most often occur for the following reasons:

• falls from high elevations;
• severe traumatic impact to the head area with a heavy object;
• classes in sports sections;
• road traffic accidents;
• various unfortunate incidents of natural or mechanical origin;
• active and extreme recreation in summer;
• formed ice in winter time of the year;
• martial arts classes;
• production non-compliance with safety rules.

First signs

Depending on the nature and severity of the injury, the signs may differ slightly from each other, but experienced doctors have identified general symptoms of a skull fracture, which will significantly help in diagnosing it:

• increased and persistent headaches;
• severe nausea and aspiration of vomit;
• formation of bruises around the eye area symmetrical to each other;
• poor or completely absent reaction of the eye pupils;
• at strong pressure the functioning of the respiratory function and circulatory process worsens on the brain stem;
• bleeding from the nose and ears;
• disruption of the cardiovascular system;
• severe agitation or complete immobilization;
• confusion or loss of consciousness;
• uncontrolled urination.

As soon as such signs are detected, immediately seek qualified assistance and adequate treatment.

First aid for a skull fracture

First of all, as soon as there is a suspicion of skull fractures - call an ambulance, who can immediately provide the necessary assistance and stabilize the victim’s condition.

If the victim is conscious and his condition seems stable, put him in horizontal position, under no circumstances using pillows. Next, you need to completely fix the head and upper part. human body using improvised objects. The wounded area must be treated with any antibacterial agents and a sterile bandage applied to it. If the ambulance team is delayed, use ice compresses to improve the patient’s condition. If no problems with respiratory functions are found, give the victim any painkiller.

In a state of unconsciousness, the patient is also placed on a hard surface, but in a sideways position, the head of the injured person is turned on its side so that vomit that may occur during injury does not cause aspiration. All items of clothing and accessories must be removed, and the victim’s body must be secured in a half-turn using bolsters or a blanket.

If the respiratory function has been disrupted, then the victim needs to undergo a procedure artificial respiration. In the case of intense hemorrhages and a drop in blood pressure, a solution of polyglucin or gelatinol is used, which is administered to the patient intravenously. If the victim is in an excited state, then there is a need to administer the drug suprastin.

You need to approach the pain relief procedure very responsibly, since some medications can increase the intensity of hemorrhage.

Diagnostic methods

First of all, upon arrival at the medical facility, the doctor finds out from the patient or his accompanying person the reasons for the occurrence of this injury and its first signs.

Then, to rule out neurological damage due to a fracture of the skull bones, the doctor conducts a study to determine the correct functioning of the senses, muscles and reflexes. The pupils of the eyes are also examined to understand whether they have a reaction to light rays, the stability of blood pressure and the position of the tongue are checked.

After confirmation or exclusion neurological abnormalities– the doctor proceeds to the installation accurate diagnosis. To establish the nature and identify the presence of injury, a qualified doctor prescribes full examination using radiography in two projections, as well as computer and magnetic resonance imaging.

Very often the unstable condition of the patient interferes with diagnostic methods and confirmation of the diagnosis, and the structure bone tissue does not detect skull fractures. In such situations, doctors prescribe treatment based on their professionalism and the signs of damage.

Treatment tactics

Depending on the severity of the injury, an experienced specialist chooses treatment tactics; it can be either conservative or surgical.

The conservative method of treatment consists of following all recommendations prescribed by the doctor. The main thing in this therapeutic method is to adhere to strict bed rest. At intervals of 2-3 days, the patient undergoes a lumbar puncture procedure to reduce the amount of fluid that enters the organs during injury. Doctors also perform a subarachnoid insufflation procedure. In parallel with this, the patient must take medications that are aimed at reducing the production of cerebrospinal fluid - diuretics.

Physical stress should be avoided for six months. The patient must be registered in the trauma and neurological office for some period after recovery.

If any other treatment methods are needed, the doctor will prescribe them individually for each patient.

For severe injuries, treatment is carried out by surgical intervention. Its task is to remove broken bone fragments and tissue areas that have undergone necrosis. And also during the operation, experienced specialists pump out the blood accumulated in the organs, and the condition is normalized nerve endings and vessels. Similar manipulations are carried out under general anesthesia.

Internal intervention may also be required when infection occurs during a fracture. purulent infection, and antibiotics and other medications cannot cope with it. In such cases, surgical intervention is prescribed by a qualified neurosurgeon who has fully studied the patient’s medical record and the nature of the existing injury.

After complete completion of treatment, the start of rehabilitation period. It is aimed at developing and restoring the motor functions of the human body, since with prolonged immobilization, muscle atrophy often develops, and performance is significantly deteriorated because of this. Rehabilitation consists of compliance correct mode nutrition, exercise physical therapy, visiting specialized massage and physiotherapy procedures. The duration of the recovery period also depends on the diagnosis and is determined by your attending physician.

Possible complications

If treatment is not provided in a timely manner or medical recommendations are not followed, unpleasant consequences may develop after a skull fracture:

• partial or complete loss of hearing and vision;
• the occurrence of meningitis;
• development of pneumocephalus;
• decreased mental abilities;
• Children after injury are significantly delayed in development;
• complete or partial paralysis of the human body;
• the occurrence of epilepsy;
• constant headaches;
• cerebral hypertension.

It is advisable to subdivide fractures of the skull bones into convexital and basal, while it must be remembered that in case of severe traumatic brain injury, cracks starting in the area of ​​the cranial vault can spread to its base.

Depending on the nature of the fracture, there are cracks, comminuted fractures, fractures with a bone defect - perforated fractures.

With a traumatic brain injury, suture dehiscence may occur, which is not essentially a fracture. Not required for calvarial fractures special treatment. Over the course of several weeks, the defects in the area of ​​the crack are filled with connective tissue, and later with bone tissue.

In case of splintered bone injuries, indications for surgery arise if there is a deformation of the skull with displacement of fragments into its cavity - a depressed fracture.

With depressed fractures, there is often concomitant damage to the dura mater and brain. Surgery is indicated in almost all cases, even if there are no neurological symptoms. To eliminate a depressed fracture, a skin incision is made in such a way as to widely expose the fracture site and maintain a good blood supply to the bone flap. If the fragments lie freely, they can be lifted using an elevator. In some cases, a burr hole is placed near the fracture site through which a lift can be inserted to mobilize depressed bone fragments.

When there is a rupture of the dura mater and concomitant damage to the brain, the defect in the mater expands to a size that allows for a revision of the brain. Blood clots and brain detritus are removed. Careful hemostasis is carried out. If the brain does not protrude into the wound, the dura mater must be sutured tightly (defects in it can be closed with the help of an aponeurosis). The bone fragments are placed in place and fixed to each other and to the edges of the bone defect with wire (or strong ligature) sutures.

If, due to high intracranial pressure, the brain begins to prolapse into the wound, it is not possible to suture the dura mater. In these cases, it is advisable to perform its plastic surgery using a periosteal aponeurotic flap, fascia lata of the femur, or artificial dura mater substitutes. Bone fragments are removed. To prevent possible liquorrhea, soft tissues must be carefully sutured in layers.

If the wound becomes contaminated, it is advisable to remove bone fragments due to the danger of osteomyelitis and perform cranioplasty after a few months.

In case of old depressed fractures, it is impossible to eliminate the deformation of the skull using the described method due to the strong fusion of the fragments with each other and with the edges of the bone defect. In these cases, it is advisable to perform osteoplastic trepanation along the edge of the fracture, separate the fragments, give them a normal position and then firmly fix them with bone sutures

Fractures of the bones of the base of the skull. Fractures of the bones of the base of the skull, as noted earlier, are usually accompanied by contusions of the basal parts of the brain, brainstem, and symptoms of damage to the cranial nerves.

Fractures of the base of the skull usually take the form of cracks, often passing through the accessory groove of the ear of the nose, the sella turcica, and the pyramid of the temporal bone. If the membrane and mucous membrane are damaged at the same time as the bone paranasal sinuses, then there is a danger of infection of the brain, since a communication occurs between the cerebrospinal fluid spaces and the accessory airways (such damage is regarded as penetrating)

Symptoms of Skull Fractures:

The picture of a fracture of the bones of the base of the skull includes general cerebral symptoms, signs of stem disorders, damage to the cranial nerves, bleeding and liquorrhea from the ears, nose, mouth, nasopharynx, as well as meningeal symptoms. Bleeding from the external auditory canal is often observed (with a fracture of the temporal bone pyramid in combination with a rupture eardrum), nose (with a fracture of the ethmoid bone), mouth and nasopharynx (with a fracture of the sphenoid bone). Liquorrhea or leakage of blood containing cerebrospinal fluid indicates the presence, in addition to ruptures of the mucous membranes and fractures of the bones of the base of the skull, damage to the dura mater. Bleeding from the nose and ears becomes diagnostic value only in cases where it is combined with neurological symptoms and if it is possible to exclude how causative factor rupture of the mucous membranes during a bruise or eardrum under the influence of a blast wave. Such bleeding is minor and easily stopped. Abundant and prolonged bleeding usually indicate the presence of a fracture.

With fractures in the area of ​​the anterior cranial fossa, bruises often occur in the eyelids and periorbital tissue (“glasses”). It may also be a bruise due to local contusion of soft tissue. Typical for fractures of the bones of the base of the skull is the pronounced and symmetrical nature of bruises in the form of “spectacles,” sometimes with their late development and exophthalmos. With fractures in the area of ​​the middle cranial fossa, the formation of a hematoma under the temporal muscle is possible, which is determined by palpation in the form of a doughy tumor. Bruising in the mastoid area can occur with fractures in the posterior cranial fossa.

Feature clinical manifestations Fractures of the base of the skull are caused by damage to the cranial nerves. More often there is damage to the facial and auditory nerves, less often - oculomotor, abducens and trochlear, as well as olfactory, visual and trigeminal. In rare cases, with fractures in the posterior cranial fossa, damage to the roots of the glossopharyngeal, vagus and hypoglossal nerves is observed. The most common combination is damage to the facial and auditory nerves.

Course and outcome. Fractures of the base of the skull, if they are accompanied by gross damage to the basal parts of the brain, can immediately after injury or in the near future lead to death. Some patients long time are in a serious condition (disordered breathing and cardiac activity, confused consciousness), often restless and anxious. A dangerous complication early period when the integrity of the dura mater is damaged, purulent meningitis occurs. Persistent headaches (due to hydrocephalus, cicatricial changes in the membranes), damage to the cranial nerves, and pyramidal symptoms remain as persistent consequences.

The main complications of such fractures of the skull base are leakage of cerebrospinal fluid (CSF) and pneumocephalus.

There are nasal and auricular liquorrhea. Nasal liquorrhea develops as a result of damage to the frontal sinus, the upper wall of the ethmoidal labyrinth (in the area of ​​the perforated plate), with cracks passing through the sella turcica and the sphenoid sinus.

If the pyramid of the temporal bone is damaged, cerebrospinal fluid may leak through the external auditory canal or through the auditory (Eustachian) tube into the nasopharynx (auricular liquorrhea).

IN acute stage traumatic brain injury, cerebrospinal fluid may leak with a large admixture of blood, and therefore liquorrhea may not be immediately detected.

Treatment of skull fractures:

In the acute stage, treatment is usually conservative. It consists of repeated lumbar punctures (or lumbar drainage), dehydration therapy, and prophylactic use of antibiotics. In a significant number of cases, it is possible to cope with liquorrhea in this way.

However, in some patients, the leakage of cerebrospinal fluid continues weeks and months after the injury and can cause repeated meningitis. In these cases, there are indications for surgical removal of liquor fistulas. Before surgery, it is necessary to accurately determine the location of the fistula. This can be done by radioisotope research with the introduction of radioactive drugs into the cerebrospinal fluid or using computed tomography and magnetic resonance imaging, especially if these studies are combined with the introduction of special contrast agents into the cerebrospinal fluid.

For nasal liquorrhea, trepanation of the frontal region is usually used. The approach to the location of the cerebrospinal fluid fistula can be carried out both extra- and intradurally. It is necessary to carefully close the dural defect by suturing or repair using aponeurosis or fascia.

The bone defect is usually closed with a piece of muscle.

If the source of the CSF rhea is an injury to the wall of the sphenoid sinus, a transnasal approach with sinus muscle tamponade and a hemostatic sponge is usually used.

With cracks in the bones of the base of the skull passing through the air cavities, in addition to the leakage of cerebrospinal fluid, air may enter the cranial cavity. This phenomenon is called pneumocephalus. The reason is the emergence of a kind of valve mechanism: with each inhalation, a certain amount of air enters the cranial cavity from the paranasal sinuses, but it cannot come back out, because when exhaling, the sheets of torn mucous membrane or dura mater stick together. As a result, a huge amount of air can accumulate in the skull above the cerebral hemispheres, causing symptoms of increased intracranial pressure and brain dislocation with rapid deterioration of the patient’s condition. Air accumulated in the skull can be removed using a puncture through a burr hole. In rare cases, it becomes necessary to surgically close the fistula in the same way as is done for liquorrhea.

With fractures of the base of the skull passing through the optic nerve canal, blindness may occur due to contusion or compression of the nerve by a hematoma. In these cases, intracranial intervention with opening of the canal and decompression of the optic nerve is justified.

Cranioplasty. The consequences of traumatic brain injury can be a variety of, often extensive, defects of the skull. They arise as a result of comminuted fractures; if it is impossible to save a bone flap due to high intracranial pressure and prolapse of the brain in surgical wound. Bone defects can be caused by osteomyelitis if the wound becomes infected.

Patients with large bone defects react to changes in atmospheric pressure. The development of a scar-adhesive process along the edges of the bone defect can cause pain syndromes. In addition, there is always a danger of damage to areas of the brain not protected by bone. Cosmetic factors are also important, especially for frontobasal defects.

These reasons justify the indications for cranioplasty.

Defects in the convexital parts of the skull can be closed with the help of prostheses made of fast-hardening plastic - styracryl, galacost. While this polymer is in a semi-liquid state, a plate corresponding to the skull defect is formed from it. To avoid the accumulation of blood and exudate between the dura mater and the plastic plate, several holes are made in the latter. The graft is firmly fixed with sutures to the edges of the defect. Tantalum plates and mesh are also used to close bone defects.

Recently, the bone of the patient himself has been used for cranioplasty. For this purpose, a symmetrical area of ​​the skull is exposed and a bone fragment corresponding in size to the bone defect is cut out. Using special oscillating saws, the bone flap is separated into two plates. One of them is placed in place, the other is used to close the bone defect.

A good cosmetic effect can be obtained by using specially processed cadaveric bone for cranioplasty, however, recently the use of this method has been refrained due to the risk of infection with the virus of slow infections.

The most difficult cranioplasty is for parabasal injuries, including frontal sinuses, walls of the orbit. In these cases it is necessary complex operation on skull reconstruction. Before surgery, the extent and configuration of bone lesions should be carefully studied. Great help in this case, volumetric reconstruction of the skull and soft tissues of the head using computed tomography and magnetic resonance imaging can help. To restore the normal configuration of the skull in these cases, the own bones of the skull and plastic materials are used.

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Other diseases from the group Diseases of the nervous system:

The concept of traumatic brain injury combines damage to the integrity of the bones of the skull, damage to the brain, membranes and choroid plexuses. A skull fracture is life-threatening and leaves serious consequences. The ability to identify characteristic symptoms damage.

Classification of traumatic brain injuries

Types of skull fractures are classified by location, level of defect, morphological characteristics. Based on location, injuries to the facial and brain parts are distinguished. Base injuries are divided into fractures of the anterior, middle and posterior cranial fossa. Types of bone defects are classified according to the level of damage as open and closed. Integrity violation skin and bones indicate the presence of a skull. Often such situations arise as a result strong blow on the head, falls from a height and into water, road accidents.

This type of fracture is dangerous due to bleeding and the development of infection in the wound canal. For injuries with intact hairline, not counting scratches and abrasions, a closed type of fracture is diagnosed. The direction of the blow is important. Skull fractures occur at the point of application of force or as a result of transmission of force from other parts of the body (direct or indirect).

Classification according to morphological characteristics includes:

• linear (local and remote);
• comminuted depressed;
• penetrating perforated-depressed;
• multiple linear;
• combined.

According to the severity, contusions are divided into mild, moderate and severe types.

Closed head injuries include:

• injury;
• compression;
• base fracture;
• vault cracks.

Signs

At the base of the skull there are areas of the brain where the centers of vital functions of the body are located. Therefore, a fracture of the base of the skull is often fatal. Signs of this kind of defects are divided into general and local.

Common manifestations characteristic of injuries of any location include:

• disturbances of consciousness;
• intense headaches;
• nausea, vomiting;
• paraorbital hemorrhages;
• loss of pupillary response;
• bleeding and liquorrhea from the nasal passages and external ear canals;
• breathing and heart rhythm disturbances;
• sudden agitation or complete immobility.

Signs of a skull fracture will correspond to the presence or absence of displacement of bone fragments. Open injuries are indicated by visible violations of the integrity of the scalp, bleeding, deformation and crepitus in the area of ​​injury. Brain and focal neurological symptoms develop in accordance with the severity of the injury.

Loss of consciousness accompanies all types brain injuries. Severe conditions are accompanied by the development of shock. Decreasing arterial pressure, breathing quickens, heart rhythm disturbances occur, cold appears sticky sweat. Brain symptoms indicate an increase in edema.

Damage to the sphenoid and ethmoid bones is not visible when external inspection. Therefore, head injuries should be regarded as possible fractures at the first stage.

Symptoms of a skull fracture

In case of a skull fracture, in addition to general symptoms, there are also local ones. Their appearance depends on the location of the line of destruction and the degree of damage to the brain tissue. Fractures of the temporal bone are accompanied by destruction of the facial nerve canal and inner ear. Clinically will be manifested:

• bleeding from the ear;
• leakage of cerebrospinal fluid;
• the appearance of behind-the-ear hematomas;
• hearing loss;
• vestibular disorders;
• development of facial asymmetry;
• loss of taste.

Injuries to the base of the skull are divided into fractures in the anterior, middle and posterior cranial fossae. The most severe symptoms develop when the brain stem is damaged, which threatens to disrupt the functioning of the cardiovascular and respiratory systems. Patients with this type of injury often develop a coma. Destruction of the bones of the arch is characterized by the presence of a hematoma or wound in the scalp area. General symptoms depend on the volume of destruction.

A fracture of the base of the skull is accompanied by damage to the optic and olfactory nerves, rupture of the membrane of the brain, followed by the formation of a communication channel with the external environment. Similar situation leads to development inflammatory diseases brain The most common fractures occur in the area of ​​the middle cranial fossa. specific gravity among this type of damage is about 70%.

Diagnostics

Patients with fractures and head injuries undergo a complex of diagnostic examinations, which include:

• collection and analysis of complaints;
• mandatory examination by several specialists;
• instrumental diagnostic methods;
• laboratory research.

A fracture of the base of the skull requires clarification of the mechanism of the injury and determination of its severity. Interviewing the patient or relatives, the type of impairment of consciousness, the presence of focal symptoms, and examination data make it possible to judge the severity of the injury and choose treatment tactics.

Traumatization of brain tissue is accompanied by intracranial hemorrhages, in the diagnosis of which lumbar puncture plays an important role. Cerebrospinal fluid analysis evaluates several parameters. When severe injuries The victims undergo radiography and contrast angiography of the cerebral vessels. This will clarify the location of the fracture, morphological structure, and determine the presence of a hematoma.

By using computed tomography define:

• intracranial hematomas;
• fractures;
• localization of the lesion;
• degree of brain compression;
• presence of edema;
• damage to the meninges.

Computed tomography is the method of choice for an accurate diagnosis of basal skull fracture. Severe injuries are often accompanied by the development of shock, which serves as an obstacle to instrumental studies. In such cases, only the clinical picture remains diagnostic criterion, and after stabilization of the state it is confirmed additional methods diagnostics

First aid

Timely and correct first aid for a fracture of the base and vault of the skull will ensure recovery and a favorable prognosis. Algorithms developed first aid. These actions include:

• assessment of the level of consciousness and general condition of the body;
• identifying the presence of wounds, the source of bleeding;
• resuscitation measures if necessary;
• organizing transportation of the victim.

Characteristic disturbances of consciousness: confusion, stupor or coma. Open views injuries are accompanied by bleeding. Necessary:

1. Apply an aseptic bandage. If there are bone fragments, the bandage will be ring-shaped.
2. Check for pulse and spontaneous breathing.
3. If necessary, ensure airway patency and immediately begin cardiac massage and artificial respiration.

A fracture of the base of the skull is accompanied by leakage of blood and cerebrospinal fluid from the nasal passages and ear canals. Requires correct position and fixation of the head. In the absence of consciousness, the victim is placed on his side to prevent aspiration of vomit and retraction of the tongue. Cervical region the spine is fixed to prevent careless movements.

The victim must not be left in a sitting position, moved or left unobserved. Drugs should not be administered for pain relief. You should not try to remove bone fragments from the wound; applying a ring bandage will be a sufficient measure.

Two thirds of severe head injuries result in death due to failure to provide and violation of first aid rules.

Treatment

Victims with skull injuries are treated in neurosurgical departments of hospitals. Fractures of the skull bones, small cracks can be conservative therapy. The goal of such therapy is to reduce, normalize cerebral blood flow, restore metabolic and energy-saving processes. During the treatment process, measures are taken to eliminate and prevent the development of purulent complications.

Treatment of skull fractures, concussions and brain contusions in some cases does not require surgical intervention. Patients with such injuries are consulted by a surgeon, ophthalmologist, otolaryngologist and neurologist. The effectiveness of treatment depends on the overall efforts, the patient’s health condition and the implementation of all manipulations.

Surgery

Severe skull injuries and life-threatening complications are indications for surgery. The need for intervention arises in the following cases:

• depressed comminuted fractures;
• compression of the brain;
• impossibility of stopping the flow of cerebrospinal fluid;
• the appearance of purulent complications;
• damage to the optic and facial nerves;
• formation of intracranial hematomas.

Fractures of the cranial vault, complicated by the formation of hemorrhages, bleeding or the presence of depressed bone fragments, are subject to surgical treatment. The surgical technique and choice of anesthesia depend on the severity, location and size of the lesion. During the operation, the depressed fragments are removed, foreign bodies, conduct an audit of the subdural space to identify and eliminate hematomas. After elimination intracranial hemorrhage sanitize the cavity and remove the source of bleeding.

Concussion foci with closed types of injuries are dangerous due to the increase in edema. In such cases, craniotomy is performed. If the outcome of the surgical intervention is favorable, plastic surgery of the bone defect is performed.

Conservative treatment

This method of therapy gives a positive result in cases of pulmonary contusion and medium degree gravity. A fracture of the skull vault responds well without complications conservative treatment. During the period of hospital stay the patient must comply with bed rest. The head end of the bed is raised to reduce the release of cerebrospinal fluid.


Drug therapy is aimed at reducing fluid levels in the body. For this purpose, diuretics are prescribed. Dehydration therapy is provided by lumbar punctures, the frequency of which is determined by the attending physician.

Due attention is paid to the prevention of purulent complications from the first day of treatment. Sanitation of the nasopharynx, oral cavity and ear canals is carried out regularly. Apply antibacterial agents. If the cranial cavity is infected, antibiotics are administered endolumbarally. After the end of the inpatient stage of treatment, patients are limited physical exercise for several months.

Consequences and survival

The consequences of injuries to bones and brain tissue significantly affect the quality of life. A fracture of the skull bones often causes disability. It is customary to distinguish between complications that occur immediately after injury and over time. The category of direct complications includes:

• intracranial hemorrhages;
• damage to brain tissue, blood vessels and nerves;
• infectious processes in the cranial cavity.

Trauma to brain tissue will always be accompanied by rupture of blood vessels. Hematomas large sizes their pressure disrupts brain function. Damage to the nerves causes loss of hearing, vision, smell, and sensitivity. The development of infection in the wound contributes to the onset of inflammatory diseases of the brain. Encephalitis, meningitis, and brain abscesses are severe complications of such injuries.


A linear skull fracture has long-term consequences. This type of fracture is common in children and accounts for more than two-thirds of skull injuries. Category long-term consequences are:

• encephalopathy;
• epilepsy attacks;
• paresis and paralysis;
• cerebral hypertension.

The cause of such complications is the formation of scar tissue and impaired regeneration of damaged nerves. The malignant course of hypertension leads to stroke. Over time, personality changes appear.

Complicated fractures are characterized by an extremely severe condition and unpredictable consequences. Death possible at any stage of treatment and rehabilitation. Rehabilitation therapy for such injuries lasts for years. For some patients, returning to a full life is impossible.

Which doctor should I contact?

A head injury of any severity should not be ignored, as it is dangerous due to complications, including delayed ones. Given the seriousness of the problem, patients with skull injuries are treated under the supervision of neurosurgeons, traumatologists, and neurologists. Non-displaced fractures and skull cracks in the absence of intracavitary hematomas do not require long-term rehabilitation. Patients return to their normal lifestyle over time.

Patients with complications after fractures need complex treatment. This is the basic principle of the recovery period, so it should take place in rehabilitation centers.

A fracture of the calvarial bones always leaves serious consequences, and the recovery period is long. Doctors from several specialties work with patients. In many ways, the positive outcome depends on the victim himself. The modern level of development of medicine and the proper qualifications of doctors increase the chances of recovery.

Not a single person is insured against an accident. Such a nuisance can happen to any of us, and therefore everyone needs to have at least a general idea of ​​how to behave in such situations and what consequences they may face. As practice shows, one of the most common accidents that a person can face is injuries. They may be on different areas body and in some cases cause bone fractures. The topic of our conversation today will be a fracture of the skull bones, we will consider its possible consequences and signs, we will discuss the features of this state in a little more detail, and also clarify what assistance should be provided to the victims.

A skull fracture is a condition in which the integrity of the bones of the skull is disrupted. Such a disorder can develop due to severe direct trauma: a strong blow, a fall from a height, trauma from an accident, etc.

What are the types of skull fractures?

Doctors identify fractures of the brain and facial skull. A separate branch of medicine deals with injuries to the facial skull; such injuries are treated by maxillofacial surgeons.

Correction of skull fractures is the field of expertise of neurosurgeons, traumatologists and surgeons.

All such conditions are divided into two main groups: fractures of the vault and the base of the skull. The latter are quite rare.

Fractures of the calvarium can be linear, depressed or comminuted. In the first case, the bone damage looks like a thin line and the bone fragments do not move. Damage to the meningeal arteries is possible, as is the formation of epidural hematomas.

Depressed fractures are accompanied by depression of the bone into the skull, which can lead to damage to the dura mater, blood vessels and brain matter. The victim is diagnosed with bruises and brain injuries, as well as various hematomas.

With comminuted fractures, several fragments are formed that can damage the brain, as well as the meninges. This leads to the same consequences as with depressed fractures.

Sometimes fractures of the vault and base of the skull are combined.

Signs of a skull fracture

Fractures of the calvarium are accompanied by a wound or hematoma on the scalp. When palpating, you may notice indentations. But with a linear fracture there are no such impressions.

Symptoms of a skull fracture are determined by the severity of the injury and the extent of the damage. brain structures. The victim may experience a variety of disturbances of consciousness: his momentary loss, and even coma.

Damage to the brain and cranial nerves leads to sensory disturbances, paresis and paralysis. Brain edema may develop, which makes itself felt by nausea, progressing to vomiting, bursting headache, disturbances of consciousness and focal symptoms. Compression of the brain stem leads to respiratory and circulatory problems, and there is also a suppression of pupillary response.

With an intracranial hematoma, the victim first develops a period of lucidity, which is eventually replaced by loss of consciousness. Therefore, the satisfactory condition of the victim does not always indicate a minor severity of the injury.

If a fracture of the base of the skull occurs, its symptoms depend on concomitant brain damage, as well as on which particular cranial fossa was damaged.

So, with a fracture of the anterior cranial fossa, the symptom of “glasses” develops - the patient experiences hemorrhages in the area of ​​tissue near the eyes, and cerebrospinal fluid mixed with blood begins to leak from the nose. Bulging of the eyes (exophthalmos) may occur.

When the middle cranial fossa is fractured, cerebrospinal fluid leaks from the ears, and a bruise also forms on the back wall throats.

A fracture of the posterior cranial fossa leads to the development severe disorders blood circulation and breathing, bruising is observed in the area of ​​the mastoid process (the bony protrusion behind the ear).

It should be noted that many symptoms do not occur immediately after the injury, but twelve to twenty-four hours after it.

Providing assistance with a skull fracture

If you suspect a fracture of the skull bones, you must immediately take the victim to the inpatient department. In this case, the patient is placed horizontally (in consciousness - on his back, in an unconscious state - half-turned). To create the desired position, pillows, clothing, etc. can be placed under the patient’s back. At the same time, the head is turned to the side.

The presence of bleeding requires application pressure bandage. Cold is applied to the area of ​​injury. If necessary, it is necessary to eliminate the retraction of the tongue and clear the airways. Doctors can also administer analeptics or cardiac glycosides.

Consequences of a skull fracture

The consequences of skull fractures depend on the severity of the injury, the individual characteristics of the patient and the timeliness and adequacy of the care provided.

All consequences can be divided into direct (arising at the time of injury) and long-term.

The first are represented by intracerebral hematomas, which can resolve on their own or require surgical intervention. They also include infectious processes, including meningitis, encephalitis, etc. They develop when pathogenic bacteria enter the wound.

Also among the direct consequences of skull fractures is damage to the brain matter (for example, with a comminuted fracture), which can lead to loss of hearing, vision, breathing problems, etc.

Long-term consequences can occur several months and even years (up to five) after the fracture. They are most often explained by incomplete regeneration of damaged tissues and the formation of scars at the fracture site, which is fraught with compression of the nerves and vessels responsible for feeding the brain. Among the long-term consequences are paralysis and paresis, encephalopathy and mental dysfunction (from some disorientation in space to complete loss of the ability to self-care). It is also possible to develop attacks of epilepsy and severe cerebral hypertension, which is prone to a malignant course, can provoke a stroke and is difficult to treat.

If you suspect a skull fracture, an ambulance is needed health care or immediately transport the victim to a hospital department on your own.

Traditional treatment

It is worth noting that after suffering a fracture of the skull bones, a person requires quite a long rehabilitation. And for the successful recovery of the body after injury, traditional medicine can be useful.

So to resume normal activities nervous system An infusion of thyme (thyme) may be useful. Ten grams of common thyme herb should be crushed and then brew it with four hundred milliliters of hot (not boiling water). Bring the mixture over low heat to a temperature of 90-95C, then cool and strain. Drink one hundred milliliters of this medicine shortly before meals. This drink can be taken for six months.

The advisability of using traditional medicine must be discussed with your doctor.