Skull Fracture

Skull FractureCreated OnMay 3, 2020Last Updated OnMay 3, 2020byadmin You are here: Main Radiology Skull Fracture < All Topics Table of Contents Normal Skull – Lateral Anatomically the skull has inner and outer surfaces or ‘tables’ Skull X-rays show the course of vessels which indent the inner table These vascular indentations branch and taper – whereas fractures do not usually branch or taper Normal Skull – AP Sutures have a saw-tooth appearance which distinguishes them from fractures which form smooth lines Skull Fractures – AP The black lines represent skull fractures These lines are too smooth to be sutures and do not branch like the vascular markings of the skull Basal Skull Fractures Fractures of the skull base are not readily visible on plain X-rays. If injury to the skull base is suspected clinically then CT is usually indicated. Blood or cerebrospinal fluid (CSF) may leak into the para-nasal sinuses following basal skull fracture. In the context of trauma an air/fluid level seen in the sphenoid sinus is radiographic evidence of basal skull fracture. Sphenoid Air-Fluid Level No fracture is visible The air-fluid level seen in the sphenoid sinus is due to haemorrhage or CSF leakage due to basal skull fracture The other paranasal sinuses also contain blood due to facial bone injury Skull – Depressed fracture Displaced or depressed skull fractures may result in overlapping bone which causes white lines of increased density Note: The sphenoid sinus is clear – however this does not exclude a basal skull fracture Scalp haematoma and skull fracture – CT brain The bone window images show a clearly defined skull fracture Also can shows a small intracranial collection of blood in the subarachnoid space A small scalp haematoma is seen on both the bone and the brain window images Fracture or suture? In the context of head injury, a knowledge of the appearance of normal sutures is essential to avoid misinterpretation. The sutures are found in typical anatomical locations and are characteristically jagged in appearance. Sutures have corticated edges whereas the edge of fractured skull bones are not corticated The suture is in the typical position of the lambdoid suture and it appears jagged and corticated The fracture passes across both inner and outer table of the skull in a straight line Skull fracture and suture At the interface of a suture the surface of each bone is covered by a layer of cortical bone which is continuous with inner and outer tables of the skull At the site of a skull fracture the bones are not corticated Note how straight the fracture is compared to the jagged suture Depressed skull fracture Severe trauma to the skull may result in depression of the skull bones The bone window images provide good detail of the depressed skull fracture The brain...

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