An unusual cause of depressed skull fracture in a child: A case report and review the literature
Compound depressed skull fractures occur commonly from assault with various sharp and blunt objects and Open depressed skull fractures can occur in a variety of settings. Our case was a 7 years old boy that ceiling fan falling on his head when he was playing in his room, we start treatment for him by maintenance therapy and we did relocation and reifications of that part of injured skull and after all parts of treatments we discharge him with no evidence of hematoma and brain injury. The management of choice in preventing infection from open depressed skull fractures is operative debridement and thorough irrigation. There is evidence that select cases can be safely managed without operation, The distinction between antibiotic treatment and prophylaxis is blurred, as contamination of the wound has already occurred at the time of injury. The prevalence of infective complications (Abscess, Empyema, Meningitis) after compound depressed skull fractures ranges from 4% to 10%, that is based on treatment and severity of damage. Surgery is indicated when there is definite evidence of dural penetration and in the older child with an unacceptable cosmetic appearance. Surgery is indicated when there is definite evidence of dural penetration and in the older child with an unacceptable cosmetic appearance Early operation is recommended to reduce the incidence of infection. Elevation and debridement is recommended as the surgical method of choice. Primary bone fragment replacement is a surgical option in the absence of wound infection at the time of surgery. All management strategies for open (compound) depressed fractures should include antibiotics. The risks of dural tear and brain laceration increase with the depth of the depression. In addition to intracranial hemorrhage, complications of depressed skull fractures include compression of underlying brain parenchyma, intraparenchymal bone fragments, cerebrospinal fluid leak, growing skull fracture, and cosmetic deformity. The use of subgaleal topical vancomycin powder is an option to reduce the infection rates and mortality, especially in the cases of compound depressed fractures, which is considered as a dirty wound and prone to infection. It is especially recommended in the presence of dural injury and pneumocephalus.
Keywords: Open Head Injury, Depressed skull fracture; Head trauma. TBI , ATLS.