Skull Fracture

WHAT YOU SHOULD KNOW:

• A skull fracture, also called a cranial fracture, is a break in one or more bones of the head. Your skull is made up of bones that join together including your frontal, parietal, temporal, and occipital bones. Your skull protects your brain, nerves, blood vessels, and inner ears from injury. Skull fractures commonly occur from a trauma or injury to your head. This may happen after a fall, physical attack, or motor vehicle accident. You may have headaches, dizziness, or blood or fluid coming out of your ear or nose. You may have bruising behind your ears or around your eyes. A skull fracture may also cause you to have eye or hearing problems.
  
  
• An x-ray, magnetic resonance imaging (MRI), or a computed tomography (CT) scan may be used to check for your skull fracture. You may also need an ear exam, and nerve and neurological (neuro) tests. Nerve and neuro tests are used to check for damage to your brain and nerves. You may need to wear a brace to keep your head and neck from moving. You may also need a lumbar drain, spinal tap, or surgery to treat your skull fracture. Having your skull fracture treated may help relieve your symptoms, such as pain, headaches, and dizziness. Treatment may also help prevent more serious problems, such as leaking fluid from your brain. Treating your skull fracture may also save your life.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Medicines used to treat your skull fracture may cause nausea (upset stomach), vomiting (throwing up), or stomach ulcers (sores). You may also have an allergic response to the medicines used to treat your skull fracture. You may get a rash and have low blood pressure or trouble breathing. With a lumbar drain, spinal tap, or surgery you may get an infection. With surgery, you may bleed more than expected. Your brain, nerves, and blood vessels may get damaged. You may have trouble controlling and moving your facial muscles, or you may lose feeling in areas of your face.
  
  
• Having a fracture increases your risk of getting a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• Without treatment, your signs and symptoms may get worse. Your neck pain, dizziness, and eye or hearing problems may become life long. You may lose your hearing completely. You may get a serious (very bad) infection if you are leaking fluid from around your brain. Your nerves may be injured making it hard for you to speak or swallow. You may have trouble moving parts of your face. You may also have trouble moving your arms and legs. If you do not treat your skull fracture, you may die. Ask your caregiver if you have questions or concerns about your condition, treatment, or care.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

IV:

An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

Neurologic exam:

This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.

Vital signs:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

Medicines:

You may be given the following medicines:

• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.
  
  
• Sedative: This medicine is given to help you stay calm and relaxed.
  
  
• Steroid medicine: Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling. Steroids may be needed to decrease facial nerve swelling. Steroids may help improve any weakness or paralysis (unable to move) of your facial muscles. Steroids can help a lot but may also have side effects. Be sure you understand why you need steroids. Do not stop taking this medicine without your caregiver’s OK. Stopping on your own can cause problems.
  
  
• Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.

Tests:

• Imaging tests: You may be given dye before some of these imaging tests. The dye may help your caregiver see the pictures better. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your caregiver if you are allergic to shellfish, or have other allergies or medical conditions.
  
  
  • Cerebral arteriography: A cerebral arteriography, or cerebral angiogram, is done to take pictures of the blood vessels in your head. Ask your caregiver for more information about cerebral arteriography.
    
    
  • Computed tomography scan: A computed tomography scan (CT scan) is a special x-ray using a computer to take pictures of your head. The CT scan may be used to look at your skull, brain tissue, and blood vessels.
    
    
  • Magnetic resonance imaging: During magnetic resonance imaging (MRI), pictures are taken of your head. An MRI may be used to look at your brain, skull, nerves, or blood vessels. You will need to lie still during an MRI. Never enter the MRI room with any metal objects. This can cause serious injury.
    
    
  • X-rays: You may need x-rays of your head to check for tissue swelling.
  
  
• Ear exam: An ear exam may be done to check for bleeding or discharge from your ears. You may also need tests to check your hearing.
  
  
• Electroneurography: Electroneurography is a test done to check for damage to your facial nerves.
  
  
• Electromyography: Electromyography (EMG) is a test that measures the electrical activity of your facial muscles. Your facial muscles are tested at rest and while you are using them. An EMG test may also check the nerves that control your facial muscles.

Treatment options:

• Lumbar drain: A lumbar drain may be needed to decrease pressure in your head and brain. Increased pressure in your head and brain occurs when cerebral spinal fluid (CSF) builds up. CSF is the fluid around your brain. A lumbar drain is a tube put into your lower back that will stay there for a period of time. Your excess CSF fluid will drain out of the tube. The fluid may be sent to a lab for tests. These tests help check for problems such as infection, or bleeding around your brain and spinal cord. Ask your caregiver for more information about a lumbar drain.
  
  
• Spinal tap: A spinal tap is a procedure done to drain CSF fluid and decrease pressure in your head and brain. During a spinal tap a needle is inserted into the lower area of your back. A small amount of CSF will be drained through the needle. The needle will be removed once your caregiver feels enough CSF has been drained. Your caregiver may send your CSF to a lab for tests. You may need more than one spinal tap. Ask your caregiver for more information about a spinal tap.
  
  
• Surgery: The injury that caused your skull fracture may also cause a wound (open cut or sore) in your head. If you have a wound, you may need surgery to remove damaged tissues, and prevent infection. Surgery may also be needed to fix your damaged skull bones, or to remove pieces of bone. Pins, plates, or screws may be used to hold the bones together, or to keep your spine stable. Injuries to your brain, nerves, or blood vessels may also be treated with surgery.
  
  
• Halo traction: A halo is a special device used to keep you from moving your head and neck. Halos are often used if your skull fracture is unstable (movable). Unstable skull fractures needing a halo are often in the back (occipital) area of your skull. Ask your caregiver for more information about halo traction.
  
  
• Neck brace: A neck brace may be needed to prevent you from moving your head and neck. A neck brace may be soft or hard and helps prevent further injury while your fracture heals.
  
  
• Eye patch: You may need to wear an eye patch to help correct your vision or eye movement problems.
  
  
• Vestibular rehabilitation: Vestibular rehabilitation may be needed if you are having problems with dizziness. You may be given exercises to help your balance and decrease dizziness.

Activity:

You may need to rest in bed with your head raised for a period of time after your injury. Avoid straining, such as blowing your nose or sneezing, to prevent increasing pressure in your skull. If fluid from around your brain is leaking, straining may worsen the leak.

Copyright © 2012. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Skull Fracture (Inpatient Care)