Types of Skull Fractures:

1.  Linear Fracture

• A simple crack in the skull.
• Usually not associated with significant brain damage.
• Often heals with no long-term effects.

2.  Comminuted Fracture

• Multiple fracture lines.
• Breaks into several pieces.
• Increased risk of brain injury and infection.

3.  Compound Fracture

• Several fragments are exposed to the environment.
• Higher risk of infection and brain damage.

4.  Depressed Fracture

• Bone fragments pushed inward into the brain tissue.
• Direct neurovascular injury.
• Increased risk for damages such as bruising and hemorrhage.

Skull Damage and Injury Sites:

Skull Fracture and Brain Injury

• Skull fractures sometimes cause or protect from brain injury.
• Damage may be intra-cranial or extra-cranial.

1.  Open (Penetrating)

• Bone fragments or objects breach external environment.
• Risk of infection.
• Neurovascular damage and hemorrhage.

2.  Closed (Blunt)

• Skull not broken.
• Brain tissues bruise or shear internally.

Brain Injury Types:

1.  Primary Injury

• Result directly from impact.
• Includes laceration, contusion, shearing axons.
• Damage to neurons, blood vessels, and glia.

2.  Secondary Injury

• Results from inflammation, edema, hemorrhage.
• Increased intracranial pressure leading to ischemia and neuronal death.

Mechanisms of Damage:

1.  Contusion

• Localized bruising of brain tissue.
• Mild to moderate to severe damage.

2.  Shearing (Diffuse Axonal Injury)

• Rotational forces cause axonal shearing.
• Widespread neuron and blood vessel damage.
• Often irreversible.

3.  Hematoma Formation

• Bleeding from ruptured vessels.
• Blood collection (hematoma) increases intracranial volume.
• Causes pressure on brain tissue, further damage.

4.  Hemorrhage and Increased ICP

• Bleeding compresses brain tissue.
• Collapse of blood vessels causes hypoxia.

Possible Effects of Damage

• Compression of vital centers in the brainstem:
  • Respiratory failure.
  • Loss of consciousness.
  • Coma or death if untreated.
• Herniations:
  • Parts of the brain shift into different compartments.
  • Can pinch vital areas, causing brainstem death.

Monitoring and Treatment

Imaging

• CT or MRI to visualize fractures, hemorrhages, and edema.
• Angiograms for blood vessel assessment.

Interventions

• Control ICP with medications, hyperventilation, or surgical decompression.
• Remove hematomas or repair skull fractures.
• Use ventriculostomy or cerebrospinal fluid drainage.
• Prevent secondary injury:
  • Maintain oxygenation.
  • Treat bleeding and swelling promptly.
  • Manage blood pressure.

Summary

• Skull fractures and brain injuries vary from mild contusions to severe shearing and hematomas.
• Brain damage can be localized or diffuse, with widespread neuronal loss if unmanaged.
• Early detection and intervention are essential to prevent fatal outcomes.