home Auditorium 7 Linear fracture of the occipital bone in a child. Fracture of the occipital bone: symptoms, diagnosis and treatment

Linear fracture of the occipital bone in a child. Fracture of the occipital bone: symptoms, diagnosis and treatment

The appearance of a fracture occipital bone Various head impacts may contribute. With this type of injury, you can get a brain contusion. Injuries to the occipital bone can occur as a result of car accidents, falls, and other situations. A fracture is one of the most dangerous injuries, since it is usually accompanied by a person, which can lead to a number of serious diseases that limit a person’s vitality.

A fracture of the occipital bone can be caused by a fall from a height, blows to the back of the head with a blunt hard object, or injury from a firearm. Fractures can be divided into several types:

Depressed. It can be obtained due to the impact of blunt objects on the skull. Such a fracture in most cases is accompanied by a violation of the membranes of the brain and, in particular, the contents of the brain. The result of a skull injury is a hematoma, which contributes to the displacement of brain structures.
Splintered– a fracture of the back of the head, which occurs due to the formation of fragments in it, damaging nerve tissue and forming hematomas. Such injuries to the occipital bone can disrupt the structure of its posterior part, the scales.
Linear. It represents a fracture line, bone displacement is no more than 10 mm. Linear fractures of the occipital bone are all that appear as a thin line on x-rays. A linear fracture of the occipital bone is difficult to determine. If it is accompanied by a transition to, then this can cause epidural hematomas. This type of injury may be accompanied by the development of hypertension.

There is also a classification occipital fractures, which is based on their location:

Bone fracture in the area of the foramen magnum. It can cause death. A fracture in the area of the foramen magnum is accompanied by damage to the vascular system, nerve tissue and.
Damage to the occipital scales.
Trauma to the lateral part. The condyle is located on it.
Damage to the basilar part.

A fracture of the occipital bone can be combined with other bone fractures, for example, the sphenoid or. Injuries to the first vertebra may be accompanied by fractures of the occipital condyle. They appear due to compression or lateral displacement.

Trauma code according to ICD 10

ICD 10 code: S02.1 Fracture of the occipital bone.

Causes

Fractures in the area of the foramen magnum have various reasons. For example, damage to the condyles can occur due to a car accident or a fall from a height. If we talk about the causes of linear fractures, they can be caused by direct effects on lower jaw. Other types occipital injuries appear due to gunshot wound or being hit with a heavy object from the back of the head.

This injury can occur in children under one year of age. The baby may fall out of the crib and hit the back of its head on hard objects. If such an injury is observed in a newborn child, it usually entails a rupture of the hard layer of the brain membrane.

Symptoms

There are several different symptoms of an occipital bone fracture. Firstly, breathing problems are observed. In addition, headaches, bleeding, convulsions, and leakage of cerebrospinal fluid from the nose, ear or skull occur.

Patients with this fracture experience loss of consciousness, dark circles under the eyes, nausea and vomiting. The victim also has hearing and vision impairment. Symptom of injury cranial fossa There may be a bruise in the temporal region if parts of the lateral bones are damaged.

First aid

If you suspect a traumatic brain injury, you should immediately contact a doctor at the trauma center for diagnosis and treatment. He will determine the extent of the injury. If, then there is a high probability that the condyle of the occipital bone is damaged.

Often in such cases, first aid is not provided - there is no break in the skin, so others are not aware of the possible consequences. But there are several techniques for determining injury, for example, with a bruise on the back of the head on the right, the victim does not feel right side head, left - left.

If the fracture is splintered and there is contamination, then it is necessary to treat the skin with an antiseptic (hydrogen peroxide). The person himself must be placed on his back so that his head is elevated and turned to the side, otherwise the patient’s condition may worsen due to difficulty breathing. Headaches can be relieved by applying an ice pack.

Diagnostics

Diagnosis of a linear skull fracture, like other types, is made using x-rays, which are performed in two projections. The main part of information about the injury is obtained from the results of MRI, CT, and ultrasound.

A neurologist diagnoses the type of injury, conducts an examination, checking the reflexes of the pupils, tendons and joints, and interviews the patient and observers of the incident.

Treatment

You can cope with an injury in which the base of the skull is damaged with the help of medications.

Treatment of linear fractures with transition to the base of the skull consists of preventing infection of cerebrospinal fluid by microorganisms, stopping osteomyelitis, encephalitis and other diseases.

General treatment of this pathology consists of the following steps:

Overlay sterile dressing to fix the fracture.
Stop bleeding.
Removal of hematoma.
Prescription of diuretics and antibiotics.
Puncture of the spinal canal to reduce the manifestations of hypertension inside the skull.

Surgical treatment

To treat a fracture of the occipital bone, specialists do not always resort to surgery. If on the side of the internal bone plate there are cracks in the occipital bone with a wavy contour, then it is necessary to remove the depressed fragments of the bones of the calvarium through surgical interventions. If surgery is not performed, the crack may spread wider.

The operation in most cases comes down to craniotomy, elimination of the defect of the occipital bone, suturing of the defect of the dura meninges or covering it with a flap of fascia or aponeurotic distension.

Rehabilitation

After an injury, it is necessary to follow bed rest and peace. If there are no complications, the victim is in the hospital under observation for a week. The doctor prescribes analgesics, antibiotics, etc. Patients are given a glucose solution with ascorbic acid, diphenhydramine. In some cases, sedatives are prescribed.

The recovery period for the patient depends on the degree of injury to the back of the head: from three days to several years. Some patients have to learn to walk again.

A fracture of the occipital bone of the skull is an unpleasant and sometimes fatal thing. Head impacts resulting from car accidents, falls, attacks from behind. Rarely, only the bone is damaged; usually the brain tissue suffers serious damage. When the occipital bone is fractured, the consequences can be tragic, even fatal.

Classification

Typically, a fracture of the occipital bone occurs as a result of a fall from a height, blows to the nose and back with a blunt object, or injury from a firearm. There are several types of fractures:

Depressed.
Splintered.
Linear.
Bone fracture in the foramen magnum area.

A depressed fracture is caused by blunt objects pushing the bone tissue inward. In this case, as a rule, the meninges and the brain itself are damaged. The result of vascular injury is, which leads to displacement of brain structures, herniation and other serious consequences. The outcome of the injury depends on the size and location.

Splintered - the formation of fragments that damage nerve tissue. Fragments can be of different sizes and can move relative to each other. Linear – damage in the form of a line, with bone displacement up to 1 cm.

A bone fracture in the area of the foramen magnum is life-threatening and carries severe consequences. This damages large vessels and cranial nerves, the spinal cord and medulla oblongata.

A fracture of the occipital bone rarely occurs without injuries to neighboring parts of the skull: the temporal, sphenoid or parietal bones, to which it is connected with sutures. Both open (with damage to the integumentary tissue) and closed fractures are possible.

Clinical manifestations of an occipital bone fracture

Symptoms may include vegetative manifestations, pain, bleeding, leakage of cerebrospinal fluid, the appearance seizures. Main features:

Nausea, vomiting caused by direct irritation of receptors due to impaired circulation of cerebrospinal fluid (cerebrospinal fluid).
Symptom of glasses: circles in the eye area.
Possible liquorrhea from the nose or ear: separation clear liquid usually with blood (handkerchief symptom).
Convulsive syndrome, changes in the intensity of muscle-joint and pupillary reflexes.
Loss of consciousness.
Impaired blood circulation and breathing due to damage to the brainstem.
Disorders of swallowing, hearing, vision (visual centers are located in the occipital region).

The injury leads to damage to the fourth ventricle and the release of cerebrospinal fluid from it. There may be no reaction to pupil light. Liquororrhea through inner ear occurs upon rupture eardrum due to injury. Bleeding may also occur.

A dangerous complication of a fracture of the occipital bone is infection of the brain pathogens, development inflammatory process(cm. ). Patients experience loss of consciousness up to.

Diagnosis and treatment

To establish the extent of the lesion, an x-ray examination in two projections is necessary. You may also need magnetic resonance imaging, CT, ultrasonography. The neurologist examines and interviews the patient and witnesses to the incident. The main reflexes are checked: tendon, joint, pupillary.

Elimination of the consequences of traumatic brain injuries is carried out using drug therapy or surgical intervention. Treatment consists of preventing infection by microorganisms in the cerebrospinal fluid, brain, bone tissue, prevention of osteomyelitis, encephalitis, arachnoiditis.

Therapy includes several measures:

Applying a sterile dressing to immobilize the fracture fragments.
If hematomas have formed, especially with herniation of the brain stem, its removal is indicated.
Diuretic therapy, spinal canal puncture to reduce the manifestations of intracranial hypertension.
Antibiotic therapy to prevent septic processes and infection of brain tissue.
Wound tamponade.
Treat bleeding with surgery or hemostatic drugs.

If a hematoma is detected, an operation is performed to remove it. The patient is indicated for craniotomy, since its formation is pushing aside the brain stem. In case of septic complications with the appearance of pus in the cerebrospinal fluid, the administration of antibiotics is indicated wide range action into the cavity spinal cord.

Urgent Care

If a TBI is suspected, the victim must be transported to the hospital as quickly as possible. medical institution for diagnosis and treatment. Calling an ambulance is one of the first measures. If there is a wound with contamination, it should be treated with hydrogen peroxide.

Immobilization of the victim - necessary condition. It is better to lay the victim on his back so that his head is elevated. Since vomiting often occurs with traumatic brain injuries, it is necessary to place the patient’s head on one side to prevent vomit from entering the Airways. After all, their aspiration is fraught with blocking breathing, as well as the development of aspiration pneumonia, which worsens general state sick.

Headaches can be relieved with an injection of Ketorol or an ice pack, which reduces the intensity of bleeding.

Consequences of an occipital bone fracture

Often the injury leads to disability or death. Damage to the medulla oblongata due to injuries near the foramen magnum leads to impaired breathing and circulation, which can be fatal. A coma may develop.

Disability is caused by damage to the cranial nerves and spinal cord, which is located close to the foramen magnum. If the spinal cord is damaged, the patient is paralyzed forever. Rehabilitation and careful care of the patient are necessary.

Damage to the bones of the skull and central nervous system is a lesion in which the victim requires prompt hospitalization. Delay can cost your life.

A fracture of the occipital bone is characterized by a violation of the integrity of the skull, damage to the soft tissues of the head in the occipital area. Usually this type The injury is combined with other bone fractures or concussions and bruises of the head. The fracture can be depressed, comminuted, linear, or with damage to the cranial nerves.

Causes

The first place among the causes of this type of fractures is road traffic accidents. The second place is when the patient falls, resulting in blows to the nose or the back of the head.

The third place is occupied by direct trauma associated with impact on the lower jaw with a blunt, heavy object. Additional causes include various wounds (for example, gunshots) or blows heavy objects V occipital region.

In addition to the main and additional reasons, there are accidents for which victims are not insured. Therefore, you must follow the rules traffic and behave as carefully as possible in those places where this injury can occur (for example, working in a factory, playing sports, etc.).

Symptoms

Symptoms depend on the extent of damage anatomical structures bones of the skull and its soft tissues. Thus, when severe fracture, the patient's cerebrospinal fluid will leak from the orbit and middle ear. Infection or the development of post-traumatic pneumocephalus is possible. The following symptoms are also noted:

Vomiting of gastric contents;
The presence of aspiration of vomit (perhaps this is one of the most dangerous symptoms indicating that death is possible);
Presence of regurgitation;
Meningeal symptoms are noted (it occurs due to the fact that the meninges are irritated during injury);
Convulsions;
Objectively, there are hemorrhages near the eyes, symmetrically located;
Loss of consciousness;
Decreased all reflexes (both physiological and tendon);
Upon examination, the doctor notes a narrowing or dilation of the pupils, and their reaction to light is rather weak.

Consequences

A fracture of the occipital bone is one of the most dangerous. This injury is destructive to both the brain and spinal cord. In this place and next to it there is a huge plexus nerve endings and blood vessels, damage to which can have an extremely negative impact on health.

Damage manifests itself both minimally (for example, curvature of the vertebrae, complaints of frequent migraines) and maximally (presence of meningitis, encephalitis, paralysis of the whole body, death).

Scull - an important part body, it protects the brain, vision and other systems, is formed by combining various bones. The occipital bone is one of the arch-forming elements and part of the base of the skull; it does not have a pair. Located next to the sphenoid, temporal and parietal bones. External surface is convex, and the reverse (brain) part is concave.

Structure of the occipital bone

The occipital bone consists of four different sections. Has mixed origin.

The bone consists of:

Scales.
Articular condyles.
Main body.
A large hole, which is located between the scales, condyles and body. Serves as a passage between the spine and the cranial cavity. The shape of the hole is ideal for the first cervical vertebra– Atlas, which allows you to achieve the most successful interaction.

It should be noted that if for human body While the occipital bone is a single system, in animals it can consist of several interconnected bones or elements.

Occipital scales

The scales of the occipital bone externally resemble a plate, part of a sphere in the form of a triangle. It has a concave part on one side and a convex part on the other. Due to the attachment of various muscles and ligaments to it, it has a rough texture.

On the outer, convex part, there are:

The protruding part or outer tubercle of the back of the head. Characteristic feature is that it can be felt by palpating and pressing on the occipital region of a person’s head. This is where bone ossification begins.
From the most protruding part, two lines run in the lateral direction, one on each side. The one between the lower and higher edges is called the “upper nuchal line.” Higher from her, starting from upper limit, the highest line originates.
The external crest of the occiput begins from the place of ossification, and continues along the midline to the posterior border of the foramen magnum.
The lower nuchal lines originate in the outer ridge of the head.

The internal region reflects the shape of the brain and the attachment points of its membranes to areas of the occipital bone. Two ridges divide the concave surface into four different areas. The intersection of both ridges is called the “cruciform hill.” The center of the intersection is known as the internal occiput.

Lateral portions of the occipital bone

The lateral parts are located between the scales and the body, responsible for the connections of the entire skull and spinal column. To do this, condyles are located on them, to which the first cervical vertebra, the atlas, is attached.

They are also responsible for limiting the foramen magnum, forming its lateral parts.

Body or main region of the occipital bone

The main characteristic is that as it matures, this bone fuses firmly with the sphenoid bone of the human skull. The process is completed by the age of seventeen or twenty.

The densest part resembles a regular quadrangle in its shape. Its extreme region is one of the sides of the foramen magnum. In childhood it has gaps filled with cartilage tissues. With age, the cartilage component turns to stone.

Development of the occipital bone

Intrauterine development.

During fetal development, the occipital bone includes:

Occiput – everything that is located below the upper nuchal line. Belongs to the cartilaginous type. Has 6 ossified areas.
The squama is the rest of the occipital bone, located above the line. Has 2 ossification points. Ossification points are the places from which the formation of bone tissue begins.

Newborn period.

Before birth and for some time after, the bone consists of 4 elements, which are separated from each other by cartilage. These include:

base part or base;
anterior condyles;
posterior condyles;
scales

After birth, the process of ossification begins. This means that cartilage begins to be replaced by bone tissue.

After 4-6 years.

A merger takes place certain parts Occiputa. The fusion of the condyles and the base of the occipital bone lasts about 5-6 years.

Developmental anomalies of the occipital bone

Developmental anomalies include:

incomplete or absolute union of the condyles with the atlas;
change in the mass of the occipital protrusion;
the appearance of new, extra bones, processes, condyles and sutures.

Fractures of the occipital bone, their consequences and symptoms

The main causes of violation of the integrity of the occipital bone:

Accidents. The fracture occurs as a result of an airbag impact.
A fall. Most often as a result of ice.
Weapon injuries.
May occur due to injuries to adjacent bones;
Injury caused by a deliberate blow to the back of the head.

At the site of the fracture, obvious swelling and hematoma form on the skin. Depending on the type of impact, there are direct and indirect fractures:

Direct. The fracture is caused by direct traumatic impact (gunshot, blow, etc.). Most injuries are of the direct type.
Indirect, when the main force that caused a violation of the integrity of the bone occurs in other areas.

There is also a classification based on the type of damage:

Depressed fractures. Formed by the action of a blunt object on the occipital bone. In this case it turns out negative impact on the brain and its injury. Swelling and hematomas form.
The most dangerous type of fracture is a comminuted fracture, which causes significant brain damage.
A linear type fracture is safer and less traumatic. A person may not even be aware of it. Statistically, it is more typical for childhood, which is due to restlessness and great activity.

To determine the presence of a fracture, check out the main symptoms:

migraine;
significant pain in the back of the head;
the reaction of the pupils to a light stimulus is disrupted;
problems with functioning respiratory system body;
fainting and clouding of consciousness.

If you find yourself with two, three or more symptoms, consult a doctor. Remember that improperly fused bone can have a negative impact on your health. In case of a shrapnel wound, small parts of the bone can lead to fatal outcome or brain dysfunction. Fractures of any bone of the skull can lead to death, but the occipital bone is in direct contact with active centers brain and its membranes, which increases the risk.

How to treat a skull fracture?

If the doctor does not detect hematomas or disruption of brain function, then no special intervention in the fusion process will be required, and you can do without surgery. Just follow general recommendations as in a fracture or severe bruise head bones.

It is necessary to treat the damaged area. If you are not allergic to medications, you can use painkillers. Do not endure pain, because when painful sensations a person strains, which has a bad effect on damaged bones.
It is advisable not to be alone and analyze your pastime. At the first signs of loss of reality, amnesia or loss of consciousness, call an ambulance.
If the examination and photographs revealed a large displacement of the bone, then surgical intervention will have to be used. The sharp edges of a fracture can damage the brain and contribute to epilepsy or other diseases. If the patient is a child under three years of age, then as they grow up, the fracture site may begin to diverge. To eliminate the disorder, surgical intervention is necessary.

Bruises of the occipital bone

In this case most of damage accounts for soft fabrics head, and the impact on the bone is minimal. If you suspect a bruise, you need to make sure there is no concussion. How to do it? First of all, a sign of the absence of a concussion is that the person did not faint at the time of injury. If you are not sure that you remained conscious or you have a memory loss, be sure to consult a doctor, you may have a concussion or a fracture.

The consequences of a bruise are less frightening than those of a fracture, but they still exist.

These include:

problems with processing visual information, inaccuracy of vision or its sharp deterioration;
feelings of nausea and vomiting;
memory impairment, problems concentrating;
migraines, pain in various parts of the head;
problems falling asleep and staying asleep;
deterioration of psychological state.

Treatment of bone bruises

In order to avoid consequences in the future, you need to remember the date of the injury and notify your neurologist about it. This will help monitor the healing of the injury and prevent complications in the future. This point must also be taken into account when collecting anamnesis, since any head injury can affect itself after a long period of time.

After a soft tissue injury, a person needs long-term rest, preferably from a week to two or even a month. It is forbidden to practice physical culture and in general any type of physical activity.

For faster rehabilitation, provide assistance to the victim.

Long, good and sound sleep.
Minimize work visual system. It is advisable to temporarily avoid watching TV shows or working with a computer, tablet, phone or laptop. Reduce the quantity books read or magazines.
Use special folk compresses or ointments and gels prescribed by a doctor.

Perhaps the doctor will consider necessary use drug treatment.

When the occipital part is fractured, its anatomical integrity is disrupted. The injury is accompanied by bruises in the brain and other injuries.

Causes

The main causes of a fracture of the occipital bone:

car crashes;
serious falls from a high object;
damage to the nose and lower jaw;
gunshot wounds;
blows to the back of the head with heavy objects.

Symptoms

The main symptoms of a fracture of the occipital bone:

strong headache;
attacks of nausea and vomiting;
violation normal reaction pupils;
violation normal operation respiratory system and blood circulation;
confusion, there is a risk of losing consciousness;
There is an abrasion or swelling above the lesion site.

Variety

Depending on the nature and type of occurrence, fractures are:

Depressed. They occur after exposure to the occipital part of a blunt object. Characterized by a violation of the integrity of the back of the head, brain damage. At risk - blood vessels. This contributes to the gradual formation of hematomas in the dura mater of the brain. Clinical picture depends on the size. If the damage results in fragments, there is a violation of the integrity and damage to the brain.
Linear. In the photograph, such injuries appear as a thin line. On an x-ray you can see a displacement of up to one centimeter. A blurred picture is observed. Linear fractures heal without any consequences. Only in rare cases do such injuries spread to the cranial base.
Fractures cranial foramina. It is characterized by damage to the cranial nerve endings, disruption of the functionality of vital human organs and systems. Appear bulbar symptoms- impaired speech and swallowing function.
Isolated. Rare cases. The front of the skull is affected.

According to their location, fractures can be:

Direct. They are characterized by the development of deformation processes in the impact area. These are the types of injuries that occur most often.
Indirect. The damage is transmitted from other bones that are damaged.

Consequences of injury

A fracture of the occipital bone has the following consequences:

violation of the integrity of the blood vascular system;
damage to the endings of the nervous system;
paralysis of the facial and oculomotor nerve regions;
risk of hearing loss.

Most often, the risk zone falls parietal bone, less often frontal or occipital part. When crossing cranial sutures, one can draw conclusions about a strong impact on head part and damage to the dura mater of the brain. Due to this impact, a linear fracture of the occipital bone occurs in a child. It appears as a smooth transition into the cranial suture.

Diagnostics

To diagnose trauma in adults and children, craniography is used - an X-ray study without the use of contrast agents.

When examining a patient’s images, the doctor looks at the line that serves as the intersection of the fissures of the vascular grooves. Damage to the arteries and vessels located inside the base of the skull is possible. This manifestation is fraught with the occurrence of epidural hematomas.

Characteristics of the image may show raised or thickened edges of hematomas. Overall, this picture gives the impression of a depressed type fracture.

Sometimes during medical research Errors were discovered when cracks, that is, incomplete fractures, were mistaken for a vascular groove. The shadow line in this case is sharp.

Experts identify several signs of linear injury:

takes the form of a straight, narrow and unbranched line;
gray coloration of the vascular groove, its size exceeds the width of the fracture line;
gray coloring of cranial sutures, their considerable width.

A more accurate diagnosis is possible a week to a week and a half after the injury.

Treatment

If the study does not reveal hematomas or brain damage, then such damage does not require special surgical intervention - therapeutic measures are sufficient to maintain normal condition patient.

Therapy consists of treating the injury site and taking painkillers. If a person loses consciousness, he must undergo examination and diagnosis by a specialist within four hours. If the patient feels normal and there is no cause for concern, the patient is sent home.

The most important are the first few weeks after receiving the injury. During this period, the affected area gradually fills fibrous tissues. If the line of injury is narrow, ossification occurs. This process lasts from four months in children, and up to three years in adults. If the line is wide, bridges are formed in the bones.

A conservative treatment method is used when cracks in the cranial vault are observed, which smoothly continue to the base line.

Surgery is required when the bone plate is displaced more than one centimeter. There is then a risk of damage to the tissue of the meninges. Which in the future threatens the development of epilepsy.

In injuries less than 3 years old, rupture of the membrane of the brain is possible. The fracture line diverges, resulting in a defect. The shell protrudes, the bones gradually move apart in different directions even wider. Such defects are eliminated using plastic surgery.

conclusions

A linear type fracture of the occipital part does not pose a serious threat to human life. It heals without specific manifestations. However, even this, like other injuries to the skull, is fraught with the development of hypertension.

The symptoms of a fracture are obvious - not only a severe headache, but also loss of consciousness. The fracture is accompanied by nausea and vomiting. In this case, the pupils stop reacting normally, the person’s consciousness is confused, and there are no clear thoughts.

If you notice any symptoms of a fracture, consult a specialist immediately. Only timely diagnosis and the prescribed course of treatment will save you from further negative manifestations fracture