Prof. Pietro MORTINI

A fracture is a partial or complete break in the bone. When a fracture occurs, it is classified as either open or closed:
• Open fracture- the bone exits and is visible through the skin, or a deep wound exposes the bone through the skin.
• Closed fracture – the bone is broken, but the skin is intact.
Fractures come in a number of different types:
• Greenstick – incomplete fracture. The broken bone is not completely separated.
• Linear – the break is in a straight line across the bone.
• Comminuted – the break is in three or more pieces.

Causes

Fractures occur when there is more force applied to the bone than the bone can absorb. Skull fractures can occur from falls, trauma, or as a result of a direct blow or kick to the body. A child’s bone differs from adult bone in a variety of ways:
• A child’s bone heals much faster than an adult’s bone. The younger the child, the faster the healing occurs.
• Bones are softer in children and tend to buckle or bend rather than completely break.
Symptoms
The following are the most common symptoms of a fracture. However, each child may experience symptoms differently. Symptoms may include:
• Pain in the injured area
• Swelling in the injured area
• Obvious deformity in the injured area
• Warmth, bruising, or redness in the injured area

Diagnosis

The physician makes the diagnosis with physical examination and a head CT scan. During the examination the physician obtains a complete medical history of the patient and asks how the injury occurred. Diagnostic procedures may include:
• X-rays – a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film; used to measure and evaluate the curve.
• Magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.
• Computed tomography scan (Also called a CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. Skull fractures are best detailed using CT scans, including three dimensional reconstruction views.

Treatment

Specific treatment for a fracture will be determined by the physician based on:
• The patient’s age, overall health, and medical history
• Severity of the fracture
• Type of fracture
• The patient’s tolerance for specific medications, procedures, or therapies
• expectations for the course of the fracture
• The patient’s opinion or preference
The goal of skull fracture treatment is to control the pain, promote healing and prevent complications.
An open fracture (one in which the bone exits and is visible through the skin, or where a deep wound exposes the bone through the skin) is considered an emergency. Seek immediate medical attention for this type of fracture by calling 911.
Treatment may include:
• Medication (for pain control)
• Surgery – required to repair open commihuted skull fractures and some types of closed skull fracture.

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