Fracture of the bones of the vault and base of the skull, signs, consequences. Crack in the skull - symptoms and treatment

When the integrity of the bones is compromised, this defect is called a skull fracture. This condition is very dangerous for humans because it causes brain damage. The cause of this disease may be a blow to the head, a fall, or car accident. Well, since a skull fracture sometimes ends in the death of a person. It will not be superfluous to know the first symptoms that you need to pay attention to. Such knowledge will help to provide timely necessary help and save the life of the injured person.

Types of fractures

Absolutely all fractures, both bones and skull, are divided into two types, namely:

• open;
• closed.

This rule also applies to the skull. Defects in this department are also divided into two main groups.

First group. Fracture of the base of the skull. As a rule, in such a situation, cracks appear, spreading to the nose and eye socket. In the case where the blow falls on middle fossa brain part, as a result, a crack will appear next to ear canal. This fracture provokes blood flow and hemorrhage into the eye. And it won’t be difficult to find it.

Second group. Fracture of the cranial vault. The symptoms of this fracture are wounds and bruises. With this type of defect, the plate located inside suffers the most. Depressing the plate leads to injury gray matter. In addition, when vessels in the lining of the brain rupture, they form. And with, there are no obvious signs. This defect can be detected by the shape of the head; as a rule, there will be a depressed area in the hairline area, indicating a closed type injury.

4 Main Signs of a Fracture

A defect in the skull always depends on the type of damage that must be distinguished. This will help provide first aid. The most common are linear fractures. This type is not severe, but may appear additional symptoms, in the form of hemorrhage in the ear. As a rule, thanks to this sign, doctors diagnose the problem much faster, since this fracture is not always visible on an X-ray image.

When does a skull fracture occur? , the person may lose consciousness or fall into a coma. Well, if the brain nerves are also damaged, then paralysis may occur.

Quite often, with such a defect, cerebral edema appears. In this case, the victim will have the following symptoms:

1. gagging;
2. strong headache;
3. change in consciousness;
4. breathing disorder.

In case of anterior injury cranial fossa. The victim will experience bruising around the eyes, also called the “glasses symptom.” This sign, indicating a skull injury, can appear in a person within a day.

If there is a fracture of the bones of the base of the skull, then the first sign is cerebrospinal fluid coming out through the ears. A person who has received such an injury will find it very difficult to breathe.

In the case of a skull fracture in a child. As a rule, after such an injury no symptoms are observed and the baby continues to frolic because pain No. But after a while, the teenager begins to suffer from blood pressure and may even faint. This is the first signal that the skull has been damaged.

How to determine a fracture

All patients who present to the emergency room with suspected traumatic brain injury are screened for the presence of a skull fracture and its symptoms. Since further successful treatment and recovery of the patient depends on such data.

The diagnosis is made in the following way. At the beginning, the doctor conducts a visual examination and additionally asks the victim questions. Then, it is necessary to undergo a neurological examination. And only then, for a complete picture, the patient undergoes an x-ray. Additionally, the doctor may prescribe a CT scan if the X-ray image is not sufficient.

First emergency aid for a fracture

If a person is suspected of having a fracture, they should be taken immediately to medical institution. If hospitalization is delayed, the patient should be placed on his back, without a pillow.

Moreover, if a person is unconscious, he must also be placed first on his back, then turned over on his side. This must be done because the victim may choke on his own vomit. When a person has the urge to vomit, it is necessary to clean everything so that he does not choke.

And, perhaps, most importantly, even if a person feels well, he needs to be shown to a doctor and try to get this done as early as possible. Timely detection of pathology gives a chance for a complete recovery.

Treatment of a skull fracture

Any qualified doctor, in case of a skull fracture, Special attention focuses on prevention purulent complications. For this manipulation, use antibacterial medicine. At the same time, all passages of the nasopharynx and ear are washed with an antibiotic.

Typically, fractures are treated in two ways:

• classic;
• surgical.

The treatment method is selected depending on how damaged the skull was. If the defect is relatively mild, then the classic method of treatment is used. In this case, the victim must strictly observe bed rest, and a cushion is placed under the head to avoid loss of cerebrospinal fluid.

If the fracture is severe. That surgical intervention Necessarily. It is performed under local anesthesia. This manipulation saves a person’s life.

Important: The most effective specialist in this field is a neurosurgeon. Therefore, if a person has doubts and wants to get competent advice, then it is worth contacting this specialist.

Consequences

More and more often people are asking what the consequences are in case of a skull fracture. Can the victim resume his previous lifestyle? In this situation, it all depends on how severe the damage is. It is also important to know whether there was displacement during the fracture and what method of treatment was used. Basically, if there was no surgery for a fracture, then the prognosis is quite positive.

In a situation where a fracture of the base of the skull is detected, the consequences are not rosy; as a rule, such an injury sometimes leads to the development of paralysis. It is worth noting that quite often and successfully, people avoid such consequences. Therefore, everything depends only on the person himself and his desire to live.

An injury such as a skull fracture is very dangerous for a person. After all, in fact, our brain is a small universe of each person. And when a strong blow occurs, perhaps the most important person is injured human organ. It's good if the defect does not cause irreparable harm, but there are other, more dire consequences. As a result, I would like to wish all people only health and may the most dangerous injury of a skull fracture pass you by.

It is advisable to subdivide fractures of the skull bones into convexital and basal, while it must be remembered that in case of severe traumatic brain injury, cracks starting in the area of ​​the cranial vault can spread to its base.

Depending on the nature of the fracture, there are cracks, comminuted fractures, fractures with a bone defect - perforated fractures.

With a traumatic brain injury, suture dehiscence may occur, which is not essentially a fracture. Cracks in the calvarium do not require special treatment. Over the course of several weeks, the defects in the area of ​​the crack are filled with connective tissue, and later with bone tissue.

In case of splintered bone injuries, indications for surgery arise if there is a deformation of the skull with displacement of fragments into its cavity - a depressed fracture.

With depressed fractures, there is often concomitant damage to the hard meninges and brain. Surgery is indicated in almost all cases, even if there are no neurological symptoms. To eliminate a depressed fracture, a skin incision is made in such a way as to widely expose the fracture site and maintain a good blood supply to the bone flap. If the fragments lie freely, they can be lifted using an elevator. In some cases, a burr hole is placed near the fracture site through which a lift can be inserted to mobilize depressed bone fragments.

When there is a rupture of the dura mater and concomitant damage to the brain, the defect in the mater expands to a size that allows for a revision of the brain. Blood clots and brain detritus are removed. Careful hemostasis is carried out. If the brain does not protrude into the wound, the dura mater must be sutured tightly (defects in it can be closed with the help of an aponeurosis). The bone fragments are placed in place and fixed to each other and to the edges of the bone defect with wire (or strong ligature) sutures.

If, due to high intracranial pressure, the brain begins to prolapse into the wound, it is not possible to suture the dura mater. In these cases, it is advisable to perform its plastic surgery using a periosteal aponeurotic flap, fascia lata of the femur, or artificial dura mater substitutes. Bone fragments are removed. To prevent possible liquorrhea, soft tissues must be carefully sutured in layers.

If the wound is contaminated, it is advisable to remove bone fragments due to the risk of osteomyelitis and perform cranioplasty after a few months.

In case of old depressed fractures, it is impossible to eliminate the deformation of the skull using the described method due to the strong fusion of the fragments with each other and with the edges of the bone defect. In these cases, it is advisable to osteoplastic trepanation along the edge of the fracture, separate the fragments, give them a normal position and then firmly fix them with bone sutures

Fractures of the bones of the base of the skull. Fractures of the bones of the base of the skull, as noted earlier, are usually accompanied by contusions of the basal parts of the brain, brainstem, and symptoms of damage to the cranial nerves.

Fractures of the base of the skull usually have the form of cracks, often passing through the accessory groove of the ear of the nose, sella turcica, pyramid temporal bone. If the membrane and mucous membrane are damaged at the same time as the bone paranasal sinuses, then there is a danger of infection of the brain, since a communication occurs between the cerebrospinal fluid spaces and the accessory airways (such damage is regarded as penetrating)

Symptoms of Skull Fractures:

The picture of a fracture of the bones of the base of the skull includes general cerebral symptoms, signs of stem disorders, damage to the cranial nerves, bleeding and liquorrhea from the ears, nose, mouth, nasopharynx, as well as meningeal symptoms. Bleeding from the external ear canal(with a fracture of the pyramid of the temporal bone in combination with a rupture of the eardrum), nose (with a fracture ethmoid bone), mouth and nasopharynx (with a fracture of the sphenoid bone). Liquorrhea or leakage of blood containing cerebrospinal fluid indicates the presence, in addition to ruptures of the mucous membranes and fractures of the bones of the base of the skull, damage to the dura mater. Bleeding from the nose and ears becomes diagnostic value only in cases where it is combined with neurological symptoms and if it is possible to exclude how causative factor rupture of the mucous membranes during a bruise or eardrum under the influence of a blast wave. Such bleeding is minor and easily stopped. Abundant and prolonged bleeding usually indicate the presence of a fracture.

With fractures in the area of ​​the anterior cranial fossa, bruises often occur in the eyelids and periorbital tissue (“glasses”). It may also be a bruise due to local contusion of soft tissue. Typical for fractures of the bones of the base of the skull is the pronounced and symmetrical nature of bruises in the form of “spectacles,” sometimes with their late development and exophthalmos. With fractures in the area of ​​the middle cranial fossa, the formation of a hematoma under the temporal muscle is possible, which is determined by palpation in the form of a doughy tumor. Bruising in the mastoid area can occur with fractures in the posterior cranial fossa.

Feature clinical manifestations Fractures of the base of the skull are caused by damage to the cranial nerves. More often there is damage to the facial and auditory nerves, less often - oculomotor, abducens and trochlear, as well as olfactory, visual and trigeminal. IN in rare cases with fractures in the posterior cranial fossa, damage to the glossopharyngeal, vagus and hypoglossal nerves. The most common combination is damage to the facial and auditory nerves.

Course and outcome. Fractures of the base of the skull, if they are accompanied by gross damage to the basal parts of the brain, can immediately after injury or in the near future lead to fatal outcome. Some patients remain in hospital for a long time in serious condition(disorders of breathing and cardiac activity, confused consciousness), often restless and anxious. A dangerous complication of the early period when the integrity of the dura mater is damaged is purulent meningitis. As lasting consequences Persistent headaches persist (due to hydrocephalus, cicatricial changes in the membranes), damage to the cranial nerves, and pyramidal symptoms.

The main complications of such fractures of the bones of the skull base are leakage cerebrospinal fluid(liquorhea) and pneumocephalus.

There are nasal and auricular liquorrhea. Nasal liquorrhea develops as a result of damage to the frontal sinus, top wall ethmoidal labyrinth (in the area of ​​the perforated plate), with cracks passing through the sella turcica and the sphenoid sinus.

If the pyramid of the temporal bone is damaged, cerebrospinal fluid may leak through the external auditory canal or through the auditory (Eustachian) tube into the nasopharynx (auricular liquorrhea).

IN acute stage traumatic brain injury, cerebrospinal fluid may leak with a large admixture of blood, and therefore liquorrhea may not be immediately detected.

Treatment of skull fractures:

In the acute stage, treatment is usually conservative. It consists of repeated lumbar punctures (or lumbar drainage), dehydration therapy, and prophylactic use of antibiotics. In a significant number of cases, it is possible to cope with liquorrhea in this way.

However, in some patients, the leakage of cerebrospinal fluid continues weeks and months after the injury and can cause repeated meningitis. In these cases, there are indications for surgical removal cerebrospinal fluid fistulas. Before surgery, it is necessary to accurately determine the location of the fistula. This can be done by radioisotope research with the introduction of radioactive drugs into the cerebrospinal fluid or using computed tomography and magnetic resonance imaging, especially if these studies are combined with the introduction of special contrast agents into the cerebrospinal fluid.

For nasal liquorrhea, trepanation of the frontal region is usually used. The approach to the location of the cerebrospinal fluid fistula can be carried out both extra- and intradurally. It is necessary to carefully close the dural defect by suturing or repair using aponeurosis or fascia.

The bone defect is usually closed with a piece of muscle.

If the source of the CSF rhea is an injury to the wall of the sphenoid sinus, a transnasal approach with sinus muscle tamponade and a hemostatic sponge is usually used.

With cracks in the bones of the base of the skull passing through the air cavities, in addition to the leakage of cerebrospinal fluid, air may enter the cranial cavity. This phenomenon is called pneumocephalus. The reason is the emergence of a kind of valve mechanism: with each inhalation, a certain amount of air enters the cranial cavity from the paranasal sinuses, but it cannot come back out, because when exhaling, the sheets of torn mucous membrane or dura mater stick together. As a result, a huge amount of air can accumulate in the skull above the cerebral hemispheres, causing symptoms of increased intracranial pressure and brain dislocation with rapid deterioration of the patient’s condition. Air accumulated in the skull can be removed using a puncture through a burr hole. In rare cases, it becomes necessary to surgically close the fistula in the same way as is done for liquorrhea.

For fractures of the base of the skull passing through the canal optic nerve, blindness may occur due to bruise or compression of the nerve by a hematoma. In these cases, intracranial intervention with opening of the canal and decompression of the optic nerve is justified.

Cranioplasty. The consequences of traumatic brain injury can be a variety of, often extensive, defects of the skull. They arise as a result of comminuted fractures; if it is impossible to save a bone flap due to high intracranial pressure and prolapse of the brain into the surgical wound. Bone defects can be caused by osteomyelitis if the wound becomes infected.

Patients with large bone defects respond to changes atmospheric pressure. The development of a scar-adhesive process along the edges of the bone defect can cause pain syndromes. In addition, there is always a danger of damage to areas of the brain not protected by bone. Cosmetic factors are also important, especially for frontobasal defects.

These reasons justify the indications for cranioplasty.

Defects in the convexital parts of the skull can be closed with the help of prostheses made of fast-hardening plastic - styracryl, galacost. While this polymer is in a semi-liquid state, a plate corresponding to the skull defect is formed from it. To avoid the accumulation of blood and exudate between the dura mater and the plastic plate, several holes are made in the latter. The graft is firmly fixed with sutures to the edges of the defect. Tantalum plates and mesh are also used to close bone defects.

Recently, the bone of the patient himself has been used for cranioplasty. For this purpose, a symmetrical area of ​​the skull is exposed and a bone fragment corresponding in size to the bone defect is cut out. Using special oscillating saws, the bone flap is separated into two plates. One of them is placed in place, the other is used to close the bone defect.

A good cosmetic effect can be obtained by using specially processed cadaveric bone for cranioplasty, however, recently the use of this method has been refrained due to the risk of infection with the virus of slow infections.

The most difficult cranioplasty is for parabasal injuries, including frontal sinuses, walls of the orbit. In these cases, a complex operation to reconstruct the skull is necessary. Extension and configuration should be carefully studied before surgery bone damage. Great help in this case, volumetric reconstruction of the skull and soft tissues of the head using computed tomography and magnetic resonance imaging can help. To restore the normal configuration of the skull in these cases, the own bones of the skull and plastic materials are used.

Which doctors should you contact if you have skull fractures:

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Other diseases from the group Diseases of the nervous system:

Absence epilepsy Kalpa

Brain abscess

Australian encephalitis

Angioneuroses

Arachnoiditis

Arterial aneurysms

Arteriovenous aneurysms

Arteriosinus anastomosis

Bacterial meningitis

Amyotrophic lateral sclerosis

Meniere's disease

Parkinson's disease

Friedreich's disease

Venezuelan equine encephalitis

Vibration disease

Viral meningitis

Exposure to ultra-high frequency electromagnetic fields

Effects of noise on the nervous system

Eastern equine encephalomyelitis

Congenital myotonia

Secondary purulent meningitis

Hemorrhagic stroke

Generalized idiopathic epilepsy and epileptic syndromes

Hepatocerebral dystrophy

Herpes zoster

Herpetic encephalitis

Hydrocephalus

Hyperkalemic form of paroxysmal myoplegia

Hypokalemic form of paroxysmal myoplegia

Hypothalamic syndrome

Fungal meningitis

Influenza encephalitis

Decompression sickness

Childhood epilepsy with paroxysmal activity on EEG in the occipital region

Cerebral palsy

Diabetic polyneuropathy

Dystrophic myotonia Rossolimo–Steinert–Kurshman

Benign childhood epilepsy with EEG peaks in the central temporal region

Benign familial idiopathic neonatal seizures

Benign recurrent serous meningitis of Mollare

Closed injuries of the spine and spinal cord

Western equine encephalomyelitis (encephalitis)

Infectious exanthema (Boston exanthema)

Hysterical neurosis

Ischemic stroke

California encephalitis

Candidal meningitis

Oxygen starvation

Tick-borne encephalitis

Coma

Mosquito viral encephalitis

Measles encephalitis

Cryptococcal meningitis

Lymphocytic choriomeningitis

Meningitis caused by Pseudomonas aeruginosa (pseudomonas meningitis)

Meningitis

Meningococcal meningitis

Myasthenia gravis

Migraine

Myelitis

Multifocal neuropathy

Disorders of the venous circulation of the brain

Spinal circulatory disorders

Hereditary distal spinal amyotrophy

Trigeminal neuralgia

Neurasthenia

Obsessive-compulsive disorder

Neuroses

Femoral nerve neuropathy

Neuropathy of the tibial and peroneal nerves

Facial nerve neuropathy

Ulnar nerve neuropathy

Radial nerve neuropathy

Median nerve neuropathy

Nonfusion of vertebral arches and spina bifida

Neuroborreliosis

Neurobrucellosis

neuroAIDS

Normokalemic paralysis

General cooling

Burn disease

Opportunistic diseases of the nervous system in HIV infection

Skull bone tumors

Tumors of the cerebral hemispheres

Acute lymphocytic choriomeningitis

Acute myelitis

Acute disseminated encephalomyelitis

Brain swelling

Primary reading epilepsy

Primary damage to the nervous system in HIV infection

Landouzy-Dejerine scapulohumeral-facial form

Pneumococcal meningitis

Subacute sclerosing leukoencephalitis

Subacute sclerosing panencephalitis

Late neurosyphilis

Polio

Poliomyelitis-like diseases

Malformations of the nervous system

Transient cerebrovascular accidents

Progressive paralysis

Progressive multifocal leukoencephalopathy

Becker's progressive muscular dystrophy

Head injury is a collective concept. These include:

trauma to the soft tissues of the head (wounds, bruises);

trauma to the sensory organs (eyes, auditory and vestibular apparatus, nasal cavity and sinuses);

trauma to the maxillofacial apparatus;

traumatic brain injury (TBI).

Classification of skull and brain injuries

Classification of TBI by depth of injury.

closed (damage to the skull and brain without damage to the integumentary tissue);

open (damage to the skull and brain with damage to the skin or mucous membranes);

a) non-penetrating (the wound channel does not penetrate the dura mater, i.e. there is no communication between the subarachnoid space and external environment);

b) penetrating (the wound channel penetrates under the dura mater and as a result of communication between the subarachnoid space and the external environment, liquorrhea occurs, as well as infection of the cerebrospinal fluid and meninges, and there is a great danger of developing meningitis).

Classification of skull fractures:

fractures of the facial skull bones;

cranial vault fractures;

fractures of the base of the skull;

a) through the anterior cranial fossa;

b) through the middle cranial fossa;

c) through the posterior cranial fossa.

Classification of intracranial hematomas:

epidural (the source can be emissary veins, dural sinuses and the middle meningeal artery);

subarachnoid (source - sinuses of the dura mater or arteries of the brain: anterior, middle, posterior and basilar);

intraventricular (source – choroid plexuses of the ventricles);

intracerebral (source - intracerebral arteries and veins).

Classification of brain damage:

concussion (commotio cerebri);

brain contusion (contusio cerebri);

a) mild degree;

b) moderate;

c) severe.

compression of the brain (compressio cerebri).

Pathogenesis of TBI. In addition to the direct effect of the traumatic agent, the “counter-impact” of the brain freely lying in the cerebrospinal fluid against the opposite wall of the skull and bone protrusions is important. Secondary damage to the brain and cranial nerves occurs with skull fractures with displacement of fragments. In the early post-traumatic period, disturbances in hemo- and liquorodynamics pose a danger. Gross violations in the form of bleeding into the cranial cavity or severe liquor hypertension lead to compression of the brain and herniation of the medulla oblongata into the foramen magnum, which is accompanied by depression of the respiratory and vasomotor centers in it and death. Bleeding into the cranial cavity in a volume of 150 ml. fatal to humans. Local hemodynamic disturbances in the form of venous congestion, stasis and edema lead to ischemic and subsequent reperfusion (lipid peroxidation) local brain damage. Nervous tissue extremely sensitive to ischemia. Clinical manifestations depend on the functional significance of the affected area.

Clinic. There are 5 groups of symptoms for TBI:

1. General cerebral symptoms: loss of consciousness, retrograde amnesia, headache, dizziness.

2. Autonomic symptoms: nausea, vomiting, tachycardia, bradycardia, pulse instability, hypotension, impaired thermoregulation, breathing disorders.

3. Focal symptoms: cramps, paresis and muscle paralysis, expressed in impaired active movements or decreased muscle strength, absence or asymmetry of reflexes, sensory disturbances, motor and sensory aphasia (loss of speech or speech understanding, respectively). Their appearance is associated with brain contusion or intracerebral hemorrhage. Due to the intersection of nerve tracts, focal symptoms in the area of ​​innervation of the somatic nervous system appears on the side opposite to the lesion in the brain. Of particular importance are the symptoms of dysfunction of the cranial nerves: nystagmus, anisokaria, decreased direct and friendly reaction of the pupil to light, smoothness of the nasolabial fold, inability to close the eye and puff out the cheeks, tongue deviation, vestibular disorders and visual impairment. Most often, these symptoms are associated with damage to the cranial nerves themselves during fractures of the base of the skull and appear on the side of the injury. Less commonly, it is caused by damage to the nuclei in the brain stem, with pronounced autonomic symptoms.

4. Symptoms of brain compression: Compression of the brain occurs under the influence of a hematoma or depressed fractures of the skull. The classic triad of symptoms is formed by anisokaria, bradycardia and repeated loss of consciousness. The last symptom is due to the fact that after the first loss of consciousness after a blow, it returns, but at the same time, the accumulation of blood in the cranial cavity increases the pressure in it. This is accompanied by impaired venous outflow and increased cerebral symptoms up to repeated loss of consciousness. Naturally, with depressed fractures and bleeding from a large artery, this symptom does not develop. The beginning of herniation of the medulla oblongata into the foramen magnum is indicated by progressive respiratory failure and progressive hypotension.

5. Meningeal symptoms: They are a consequence of irritation of the dura mater with blood rich in pain receptors and indicate the presence of subarachnoid hemorrhage or the penetrating nature of the injury. Most of the meningeal symptoms are a type of protective muscle tension. These include:

symptom of stiff neck when bending the head;

Kernig's sign - rigidity of the flexors of the leg when trying to straighten the bent at the hip and knee joints leg;

upper Brudzinski symptom – bending of the legs with forced bending of the head;

the average Brudzinski symptom is bending of the legs when pressing on the area of ​​the symphysis pubis;

lower Brudzinski's symptom - bending of the leg when trying to straighten the other leg, bent at the hip and knee joints;

severe headache upon percussion of the zygomatic arches;

headache when looking at light;

blood in the cerebrospinal fluid during puncture.

Concussion. The main and obligatory component of the clinical picture is loss of consciousness immediately after the injury. Retrograde amnesia (the patient does not remember what happened to him immediately before the injury), headache, nausea, and vomiting is also characteristic. There are no other groups of symptoms.

Brain contusion. What is important is the appearance of focal symptoms and the severity of autonomic symptoms. With a mild contusion, loss of consciousness lasts up to 30 minutes, focal symptoms manifest themselves in the form of reflex asymmetry, the rest of the symptoms are similar to a concussion. With a moderate injury, the duration of loss of consciousness does not exceed 2 hours, focal symptoms take the form of paresis, aphasia, etc., characterized by repeated vomiting and pulse lability. In case of severe bruise, the main factors are loss of consciousness from 2 hours to several days (coma) and extreme severity of vegetative symptoms (uncontrollable vomiting, thermoregulation disorders, disturbances in cardiovascular activity and breathing until they stop). Symptoms of intracranial hypertension, cerebral compression and herniation of the medulla oblongata do not appear immediately and are associated with cerebral edema.

Brain compression. Symptoms of brain compression due to intracranial bleeding may not appear immediately after injury, but after some time ( lucid interval), therefore underdiagnosis of the injury is possible. All other groups of symptoms may occur, but their presence is secondary. The predominance of meningeal symptoms indicates subarachnoid hemorrhage, focal hemorrhage indicates intracerebral hemorrhage. Epidural hemorrhage may not be accompanied by these groups of symptoms.

Open TBI accompanied by bleeding and liquorrhea from the wound, nose or ear. Accordingly, meningeal symptoms appear. With a fracture of the base of the skull Nasal or auricular liquorrhea, hematomas in the orbital area (a symptom of glasses) and the mastoid process of the temporal bone, meningeal symptoms and signs of damage to the cranial nerves are common.

Diagnosis of TBI A fracture of the skull bones is determined by radiography in 2 projections, which is mandatory for a skull injury. Intracranial hematoma is diagnosed using echography, computed tomography, nuclear magnetic resonance imaging and the application of search burr holes. If subarachnoid hemorrhage is suspected, a spinal puncture has diagnostic value. Its technique is identical to that of spinal anesthesia. During puncture, you can assess the pressure in the subarachnoid space and the presence of blood in the cerebrospinal fluid. Spinal puncture is strictly contraindicated when the medulla oblongata is wedged into the foramen magnum.

First aid. According to indications, perform cardiopulmonary resuscitation and stop bleeding (pressure bandage, wound packing). When vomiting, the patient should be positioned in such a way that free flow of vomit is possible to avoid aspiration. An important point is the use of local hypothermia. In addition, analgesics should be used in case of pain, and an aseptic bandage should be applied in the presence of wounds. The specialized stage of providing care for TBI is the neurosurgical department. Patients with injuries to the skull and brain are transported exclusively in a prone position.

Treatment In case of a concussion, hospitalization, bed rest from 14 days to 1-2 months, dehydration therapy, the use of bromides, analgesics, tranquilizers, and, if indicated, a spinal puncture are indicated (removal of 5-8 ml of cerebrospinal fluid usually improves the patient’s condition).

Treatment of a brain contusion is conservative, the same as for a concussion, but longer bed rest is used. In the presence of paresis and paralysis, massage and exercise therapy are prescribed. For severe bruises, symptomatic treatment is carried out (antiemetic drugs, hemodynamic stimulation, mechanical ventilation). If intracranial pressure increases, repeated spinal punctures are performed.

Treatment of brain compression is only surgical - emergency craniotomy, elimination of compression by fragments, removal of hematoma and cerebral detritus, careful hemostasis. IN postoperative period Treatment is prescribed for concussions and bruises.

In case of open TBI, primary surgical treatment wounds and prescribe antibiotic therapy.

Consequences of TBI.

Direct: cardiac and respiratory arrest, aspiration of vomit, traumatic shock.

Immediate: meningitis, cerebral edema.

Remote: persistent neurological disorders (paresis, visual and hearing disorders, etc.), adhesive arachnoiditis, epilepsy.

Not a single person is insured against an accident. Such a nuisance can happen to any of us, and therefore everyone needs to have at least general idea about how to behave in such situations and what consequences they may face. As practice shows, one of the most common accidents that a person can face is injuries. They can occur in different parts of the body and in some cases cause bone fractures. The topic of our conversation today will be a fracture of the skull bones, we will consider its possible consequences and signs, we will discuss the features this state in a little more detail, and also clarify what assistance should be provided to the victims.

A skull fracture is a condition in which the integrity of the bones of the skull is disrupted. A similar disorder can develop due to severe direct trauma: strong blow, falls from a height, injuries from road accidents, etc.

What are the types of skull fractures?

Doctors identify fractures of the brain and facial skull. A separate branch of medicine deals with injuries to the facial skull; such injuries are treated by maxillofacial surgeons.

Fracture correction brain skull- This is the area of ​​expertise of neurosurgeons, traumatologists and surgeons.

All such conditions are divided into two main groups: fractures of the vault and the base of the skull. The latter are quite rare.

Fractures of the calvarium can be linear, depressed or comminuted. In the first case, the bone damage looks like a thin line and the bone fragments do not move. Damage to the meningeal arteries is possible, as is the formation of epidural hematomas.

Depressed fractures are accompanied by depression of the bone into the skull, which can lead to damage to the dura mater, blood vessels and brain matter. The victim is diagnosed with bruises and brain injuries, as well as various hematomas.

With comminuted fractures, several fragments are formed that can damage the brain, as well as the meninges. This leads to the same consequences as with depressed fractures.

Sometimes fractures of the vault and base of the skull are combined.

Signs of a skull fracture

Fractures of the calvarium are accompanied by a wound or hematoma on the scalp. When palpating, you may notice indentations. But with a linear fracture there are no such impressions.

Symptoms of a skull fracture are determined by the severity of the injury and the extent to which brain structures are damaged. The victim may experience a variety of disturbances of consciousness: short-term loss of consciousness, and even coma.

Damage to the brain and cranial nerves leads to sensory disturbances, paresis and paralysis. Brain edema may develop, which makes itself felt by nausea, progressing to vomiting, bursting headache, disturbances of consciousness and focal symptoms. Compression of the brain stem leads to respiratory and circulatory problems, and there is also a suppression of pupillary response.

With an intracranial hematoma, the victim first develops a period of lucidity, which is eventually replaced by loss of consciousness. Therefore, the satisfactory condition of the victim does not always indicate a minor severity of the injury.

If a fracture of the base of the skull occurs, its symptoms depend on concomitant brain damage, as well as on which particular cranial fossa was damaged.

So, with a fracture of the anterior cranial fossa, the symptom of “glasses” develops - the patient experiences hemorrhages in the area of ​​tissue near the eyes, and cerebrospinal fluid mixed with blood begins to leak from the nose. Bulging of the eyes (exophthalmos) may occur.

When the middle cranial fossa is fractured, cerebrospinal fluid leaks from the ears, and a bruise also forms on the back wall throats.

A fracture of the posterior cranial fossa leads to the development of severe circulatory and respiratory disorders, and bruising is observed in the area of ​​the mastoid process (the bony protrusion behind the ear).

It should be noted that many symptoms do not occur immediately after the injury, but twelve to twenty-four hours after it.

Providing assistance with a skull fracture

If you suspect a fracture of the skull bones, you must immediately take the victim to the inpatient department. In this case, the patient is placed horizontally (in consciousness - on his back, in an unconscious state - half-turned). To create the desired position, pillows, clothing, etc. can be placed under the patient’s back. At the same time, the head is turned to the side.

The presence of bleeding requires the application of a pressure bandage. Cold is applied to the area of ​​injury. If necessary, it is necessary to eliminate the retraction of the tongue and release Airways. Doctors can also administer analeptics or cardiac glycosides.

Consequences of a skull fracture

The consequences of skull fractures depend on the severity of the injury, on individual characteristics the patient and the timeliness and adequacy of the care provided.

All consequences can be divided into direct (arising at the time of injury) and long-term.

The first are represented by intracerebral hematomas, which can resolve on their own or require surgical intervention. They also include infectious processes, including meningitis, encephalitis, etc. They develop when pathogenic bacteria enter the wound.

Also among the direct consequences of skull fractures is damage to the brain matter (for example, with a comminuted fracture), which can lead to loss of hearing, vision, breathing problems, etc.

Long-term consequences can occur several months and even years (up to five) after the fracture. They are most often explained by incomplete regeneration of damaged tissues and the formation of scars at the fracture site, which is fraught with compression of the nerves and vessels responsible for feeding the brain. Among the long-term consequences are paralysis and paresis, encephalopathy and disorders mental functions(from some disorientation in space to complete loss of self-care ability). It is also possible to develop attacks of epilepsy and severe cerebral hypertension, which is prone to a malignant course, can provoke a stroke and is difficult to treat.

If you suspect the development of a skull fracture, emergency medical care or immediate transportation of the victim to a hospital department on your own is necessary.

Traditional treatment

It is worth noting that after suffering a fracture of the skull bones, a person requires quite a long rehabilitation. And for the successful recovery of the body after injury, remedies can be useful traditional medicine.

So, to resume normal activity of the nervous system, an infusion of thyme (thyme) can be useful. Ten grams of common thyme herb should be crushed and then brew it with four hundred milliliters of hot (not boiling water). Bring the mixture over low heat to a temperature of 90-95C, then cool and strain. Drink one hundred milliliters of this medicine shortly before meals. This drink can be taken for six months.

The advisability of using traditional medicine must be discussed with your doctor.

The most dangerous from a traumatological point of view is a skull fracture. Any injury to the skull is considered a traumatic brain injury because it can affect the brain. The statistics of skull fractures are sad - 1/10 of all fractures are caused by skull injuries of varying severity.

Moreover, in most cases, the victims of such fractures are young people (usually men) in a state of alcoholic intoxication. Many cases of injury occur as a result of domestic or criminal conflicts.

The skull consists of 28 paired and unpaired bones, forming the brain and visceral (facial) sections. The medulla is a cavity for housing the brain and consists of a fornix and a base. It is formed by 8 bones: paired parietal and temporal bones, and unpaired occipital, frontal, ethmoid and sphenoid bones.

The visceral section contains most of the sensory organs, and is also the initial section of the respiratory and digestive systems. It consists of 15 bones - unpaired bones of the lower jaw, vomer, hyoid and paired bones of the upper jaw, palatine, lacrimal and lower nasal.

Vault - top part skull, consisting of bones connected to each other by sutures various shapes. The names of the sutures correspond either to their shape, or to the bones they connect, or to the direction and shape. Thus, a suture in the form of a jagged line is called jagged, an even suture at the junction of one bone covering another is called scaly, etc.

The convexity in the front part of the arch is the forehead (frontal tubercle, brow ridge and the depression between them - glabella). In the back there are three convexities - the parietal tubercles and the back of the head, and between them the highest point of the arch is determined - the crown.

Below the line of the infraorbital margin is the base of the skull, composed of four fused bones - the occipital, temporal, sphenoid and ethmoid. The outer base is covered by the bones of the face, and inner surface It is divided into three fossae: the anterior and middle fossae contain the brain, and the posterior fossa contains the cerebellum.

Varieties (classification)

Due to the structural features of bone tissue, the skull is able to have a certain degree of strength and withstand significant loads without damaging the bones. However, in this case, brain damage often occurs. The localization, direction and severity of the injury are determined precisely by the unequal elasticity, the presence of nerve, venous and air openings and, associated with this, the thickness of the bone in different sections.

Like other bone injuries, skull fractures can be open or closed.

• Arch fracture - violation of integrity brain section. It can be direct, when the localization of the injury is limited to the place where the force is applied. In this case, the bones bend inward at the fracture site. With an indirect fracture, when the cracks spread to the entire skull and the bone bends outward.
• When the base is fractured, the membranes of the brain and spinal cord are often damaged, and the nerves responsible for vision, hearing and facial expressions are pinched. The fracture can be either independent or accompany a fracture of the arch. The cracks extend to the bones of the nose and eye socket, as well as the area of ​​the ear canal. Depending on the location of the lesion, the anterior, middle or posterior cranial fossa may be affected.

Based on the nature of the damage, fractures are divided into the following types:

1. Comminuted - are the most common type of fracture and its treatment is often complicated by the location of the injury, the shape and number of bone fragments. Such injuries can lead to bruises, the formation of intracerebral hematomas, and brain crushing.

2. Linear fractures can be local and distant. In the first case, a linear fracture is a crack that begins at the point of impact and spreads to the sides. Distant linear fractures differ from local ones in that the crack begins at some distance from the point of impact and spreads to this place and in the opposite direction from it.

3. Depressed fractures can be impression (when bone fragments are not separated from entire sections) and depression (bones are separated from the skull). The type of depressed fracture is determined by the following factors: the area and shape of the damaging object and its relationship with the area of ​​the skull, the force and intensity of the impact, the degree of elasticity of the skull bones and skin.

4. Perforated fractures usually result from gunshot wounds and are often fatal.

Causes and symptoms

The main causes of a fracture are impact with a blunt massive object, a fall from a standing position, a blow to the head (sports injury), as well as carelessness with additional acceleration given to the body. Moreover, the type and severity of the fracture is significantly influenced by the condition of the victim before the incident - the state of his metabolism and the presence of diseases that contribute to increased bone fragility.

Depending on the type of injury, signs of a fracture may vary, but the common ones for a skull fracture are:

• sharp pain that gets worse with slight movement,
• loss of consciousness in most cases,
• cerebral edema,
• change in the shape of the skull,
• respiratory failure.

Linear fractures are usually accompanied by the appearance of hematomas in the area of ​​the orbit and mastoid process. Hemorrhage occurs in the middle ear area. The presence of these symptoms is very helpful in making a diagnosis when the lesions are not identified on the x-ray.

A fracture of the anterior cranial fossa is accompanied by bleeding from the nose, as well as the appearance of bruises in the area of ​​the upper and lower eyelids. Sometimes subcutaneous emphysema may occur, caused by cracks in the air sinuses.

When the middle cranial fossa is fractured, damage to the temporal bone is often observed. Such fractures manifest themselves as bleeding from the ear, as they cause a rupture of the eardrum. The facial nerves are also affected.

Posterior fossa fractures involve damage to the area occipital bone when the cranial nerves are affected and impaired vital organs. Another obvious symptom of a fracture is the leakage of cerebrospinal fluid from the nose or ear.

In cases of severe damage to the frontal bone, severe headaches indicate a concussion. The symptom of a fracture is pronounced hematomas in the frontal bone, changes in the shape of the skull, dizziness, nausea, vomiting, loss of vision, loss of consciousness. There may be nosebleeds and swelling in the area of ​​impact.

If the fracture is comminuted, then general symptoms soft tissue damage is added, as well as complete or partial loss of sensitivity. In this case, part of the fragment may appear at the fracture site. Impairments of consciousness as a result of a fracture depend on the severity of the injury and can be either short-term or long-term, when the victim falls into a coma.

In children, symptoms may not appear immediately and may not appear at all for some time. Subsequently, the child begins to lose consciousness due to sudden surges in pressure. The effects of trauma become more noticeable at age 16, when frontal lobes are completing their formation. Any head injury requires a thorough examination and timely medical care.

Often victims of skull fractures are people under the influence of alcohol or drugs, which can make it difficult to identify symptoms. Therefore, in such cases, the reason for going to the hospital for examination may be bruises, wounds and hematomas of the head and other objective evidence of damage.

Providing first aid for skull fractures is a very important component of all subsequent treatment. While waiting for the ambulance to arrive, the victim must be placed on his back if he is conscious. In case of loss of consciousness, the patient is placed in a half-turn position.

The head should be placed on something soft, such as a pillow or blanket, and turned to the side so that the person does not choke if vomiting occurs. If bleeding occurs, apply a pressure bandage to the wound and apply ice to the injury site. It is imperative to check the airway to avoid tongue retraction.

Treatment

IN initial stage treatment, the circumstances of the fracture are clarified, the patient’s condition is assessed, a neurological examination is carried out, the condition of the pupils is checked, an X-ray examination in two projections, CT and MRI of the brain are carried out.

Linear fractures in most cases do not require surgical intervention. The victim needs to receive medical care, including wound treatment, pain relief and supportive care. If loss of consciousness occurs during the injury, then it must be examined by a neurosurgeon to identify violations of vital functions.

To fix the skull bones, an adhesive tile-shaped bandage is applied to the head. Within a couple of weeks, fibrous tissue forms in the area of ​​the fracture, and then bone and the fracture heals. In children, the process of fusion of the skull bones occurs over several months. In adults, this process lasts from 1 to 3 years.

The operation is performed in cases where the bone plate is displaced relative to the surface of the cranial vault by more than 1 cm. The surgeon should be extremely careful, since during such an operation there is a risk of damage to the meninges and brain tissue.\

Further treatment takes place with strict observance bed rest. In this case, the head should be kept in an elevated position. A puncture is taken every few days spinal cord to determine and reduce fluid content in organs. At the same time, oxygen is introduced into the space of the spinal cord.

After intensive therapy, the patient is prescribed a course to restore and stabilize the functioning of the cardiovascular system, respiratory organs, normalization of arterial and intracranial pressure, as well as preventing the development of brain hypoxia and reducing the neurological consequences of injury.

Rehabilitation and recovery

The rehabilitation period includes:

1. Limitation physical activity for a period of six months;
2. Observation by specialists - neurologist, traumatologist, otolaryngologist and ophthalmologist;
3. For cognitive disorders, classes are conducted to restore speech, memory, and attention.
4. Psychotherapeutic evaluation may be necessary.
5. Procedures aimed at restoring coordination and balance (aquatherapy, physiotherapy);
6. Nursing care, use anti-bedsore mattress(for somatic disorders)
7. Nutrition correction.

The optimal period of rehabilitation after a skull fracture is about 2 years after the end of treatment.

Consequences

Any damage to the skull is associated with various consequences. Some of them appear almost immediately after the incident, while others will take some time to develop.

• the entry of bacteria into the cerebrospinal fluid can trigger the development of meningitis.
• air ingress can cause pneumoencephaly.
• fractures sustained in childhood, have a significant impact on mental, physical and psycho-emotional development.
• a fracture of the skull, especially its base, can lead to complete paralysis of the body, since it is the base of the skull that connects the spinal cord and brain.

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