Cases reported "Skull Fracture, Depressed"

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1/24. Brain abscesses from neglected open head injuries: experience with 17 cases over 20 years.

    We are reviewing our experience with 17 civilian cases with post-traumatic brain abscesses treated in the era of CT scanning over a period of 20 years. The principal cause for this intracranial complication was the neglected compound depressed fracture. One was a newborn infant with left parietal abscess caused by a vacuum extraction. We have used the following methods of treating the abscesses: single burr hole aspiration in the newborn with an excellent result; repeated aspiration, with debridement of the depressed fracture, in 5 cases (1 death); aspiration with early subsequent excision, via craniotomy, in 7 cases (no death), and primary excision, via craniotomy, in 4 cases (1 death). The early subsequent excision of the abscess, 2 or 3 days after the initial aspiration, has proved in our experience very satisfactory. In cases with bone fragment into the abscess cavity the excision of the abscess is indicated. The cultured pus from the abscess cavity showed mixed flora (streptococci and staphylococci) in 7 cases; staphylococcus aureus in 4; staphylococcus epidermidis in 2, and no growth in 4 cases. Antibiotics play an important role in the treatment of post-traumatic brain abscesses.
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ranking = 1
keywords = fracture, compound
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2/24. An unusual cause of depressed skull fracture: case report.

    BACKGROUND: Camel collision accidents are a common occurrence in saudi arabia, with a high rate of mortality and morbidity. Isolated injuries are rare because of the nature of impact sustained by the person. CASE DESCRIPTION: A 4-year-old child with an isolated depressed skull fracture resulting from a camel collision is described. The other occupants of the car were crushed to death. The child sustained only an impact to his head, causing a compound depressed skull fracture with localized cortical damage. CONCLUSIONS: Camel collision accidents are a common cause of mortality and morbidity in saudi arabia. Isolated skull injuries are rare and result from a localized impact. This is the first report of a compound depressed skull fracture from such an incident. The extent of the problem and efforts toward prevention are described.
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ranking = 1074.307390717
keywords = skull fracture, fracture, skull, compound
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3/24. An unusual management of an open compound depressed skull fracture with venous sinus involvement. A case report.

    A neurosurgical management of an open compound depressed fracture perforating the superior sagittal sinus is reported. Undue bleeding from the fracture did not allow a conservative management. The patient had been operated primarily at an outside emergency surgery unit. Profuse uncontrollable bleeding made a tamponade of the sinus necessary for transportation to our neurosurgical department. After reconstruction of the sinus he survived without evidence of a neurological deficit.
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ranking = 614.61632767156
keywords = skull fracture, fracture, skull, compound
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4/24. titanium clamps for refixation of bone fragments in the repair of depressed skull fractures: technical note.

    The rigid fixation of bone fragments in the repair of depressed skull fractures can be a problem, especially if not all fragments are replaceable. Usually, in these cases mini- or microplates are used. The Craniofix titanium clamp (Aesculap, germany) was developed for the fixation of bone flaps after osteoplastic craniotomy. It consists of a screw holding together two 10-mm diameter metallic disks with concaved teeth pressing bone flap and cranium between the two disks. We used this system for the operative treatment of two patients with depressed skull fracture. A rigid fixation of the bone fragments was achieved in both cases. The postoperative three-dimensional CT scan showed a good fragment alignment. From the report of two cases we show that this system is a useful tool in the fixation of bone fragments in the repair of depressed skull fractures.
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ranking = 921.40082017743
keywords = skull fracture, fracture, skull
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5/24. Traumatic cranial injury sustained from a fall on the rigid external distraction device.

    Distraction osteogenesis has become a popular treatment of congenital maxillocraniofacial anomalies. Many ingenious internal and external devices have been developed and used. The rigid external distraction system based on systems previously used in correction of maxillary retrusion offers postoperative adjustment in two dimensions. Figueroa and Polley reported the use of this device with minimal morbidity in children as young as 5 years of age. They reported no problems with infection, bleeding, pain, loosening of the intraoral splint, dental injury, or wear problems in a series of 14 consecutive cleft patients. Recent modification of the system, rigid external distraction II, has allowed it to be applied to more complex craniofacial deformities that require a LeFort III osteotomy. A review of the neurosurgery and orthopedic literature revealed that halo complications relate primarily to the skull pins. In most cases, these complications can be prevented if the device is carefully applied and monitored. Early recognition and prompt treatment of complications are important. After experience with this system for advancement at the LeFort III level, six patients with various syndromes involving the craniofacial skeleton have undergone LeFort III level distraction osteogenesis with the rigid external distraction device in combination with a planned and stabilized frontosupraorbital advancement. In one of these cases, a 7-year-old child fell on the device after discharge from the hospital and sustained a compound depressed skull fracture that required debridement and repair.
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ranking = 153.89119461523
keywords = skull fracture, fracture, skull, compound
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6/24. A new method for surgical repair of impression fractures of the cranial vault and frontal sinus with rivet-like titanium clamps.

    Conventional methods of stabilizing fragments in cranial impression fracture include the use of threads, wires, plates, etc. A new approach to facilitate this surgery is the use of titanium clamps, presented here in five cases, including one with frontal sinus fracture. Surgery was performed on admission day, with the exception of the sinus fracture. Compared with the use of mini- and microplates, the procedure was simple and short. The fixation was very rigid and the esthetic result excellent in all five cases. skin irritation was minimal, compared with that from miniplates. Computed tomography and MRI compatibility due to artifacts are identical to those with miniplates.
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ranking = 3.4941932160923
keywords = fracture
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7/24. Traumatic basilar artery occlusion caused by a fracture of the clivus--case report.

    A 56-year-old man presented with a rare traumatic basilar artery occlusion caused by a fracture of the clivus. He fell from the height of 2 meters and immediately fell into a coma. head computed tomography (CT) revealed an open depressed fracture, an acute epidural hematoma 1 cm thick in the left middle frontal fossa, and a longitudinal fracture of the clivus. Emergency removal of the hematoma was performed with cranioplasty. head CT 8 hours 50 minutes after injury showed infarctions in the brain stem, cerebellum, and occipital lobes. cerebral angiography revealed occlusion of the basilar artery in the middle part of the clivus. The patient died after 3 days. autopsy revealed that the basilar artery was trapped in the clivus fracture site. Vertebrobasilar artery occlusion due to trapping in a clivus fracture has a very poor prognosis. diagnosis is difficult and generally only confirmed at autopsy. cerebral angiography is recommended in a patient in a deep coma without massive brain contusion at the early stage of head injury to identify the possibility of vertebrobasilar artery occlusion in a clivus fracture.
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ranking = 4.9917045944175
keywords = fracture
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8/24. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Tangential views or computed tomography in suspected depressed skull fracture.

    A short cut review was carried out to establish whether CT scans are better than tangential skull radiographs at detecting depressed skull fractures. No papers answering this question were found using the reported search.
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ranking = 767.49922688121
keywords = skull fracture, fracture, skull
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9/24. Cranioplasty for patients with severe depressed skull bone defect after cerebrospinal fluid shunting.

    Cranioplasty is indicated for patients with a skull bone defect. patients may achieve subjective and objective improvements after cranioplasty. Some patients with severe brain swelling treated with decompressive craniectomy may develop hydrocephalus associated with severe brain bulging or even herniation via the skull bone defect. Consequently, these patients require a ventriculoperitoneal (V-P) shunt to relieve hydrocephalus. However, after shunting for hydrocephalus, they may develop severe sinking at the skull defect. Subsequently, when doing a cranioplasty for such a depressed defect, it may result in the dysfunction of the underlying brain, or even hematoma formation due to the large dead space. In this study, we advocate a temporary procedure to occlude the V-P shunt tube to allow the expansion of a depressed scalp flap to facilitate the subsequent cranioplasty. We report four patients with severe depression of the skull defect resulting from previous traumatic brain swelling followed by decompressive craniectomy and V-P shunting for communicating hydrocephalus. A simple subcutaneous clipping of the shunt tube was performed to allow the expansion of the depressed scalp to obliterate the dead space before the cranioplasty. All four patients obtained a satisfactory result without complications and achieved good functional recovery. A temporary occlusion of the shunt tube with an aneurysm clip before cranioplasty for patients with a severely depressed scalp flap is a simple and useful procedure. This procedure can safely and effectively eliminate the dead space between the skull plate and the dura to facilitate the cranioplasty, and thus prevent the potential complication of intracranial hematoma.
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ranking = 4.3840142760439
keywords = skull
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10/24. Punched with a fist: the etiology of a fatal depressed cranial fracture.

    We report a case in which a 33-year-old man was discovered unconscious following a fistfight with another man. Emergency neurosurgical efforts to repair a depressed temporoparietal skull fracture and associated brain injuries were unsuccessful. The forensic anthropologist and pathologist worked in tandem to sort out a complex combination of cranial evidence, including healed antemortem trauma, perimortem blunt force trauma, remote and recent neurosurgical intervention, and the craniotomy cut performed at autopsy. The victim had suffered head injuries and a right temporoparietal craniotomy ten years prior to death. The perimortem cranial fractures were centrally located within a surgically repaired roundel of bone involving portions of the right temporal and parietal bones. Reportedly, the victim was punched on the right side of his head as he was lying on the ground with the left side of his head against an asphalt surface. A primary question in the case was whether a blow with a fist could have produced the observed cranial injuries. To adequately answer that question, known data on the minimum amount of force required to fracture the temporoparietal region were compared to data on the amount of force generated by a blow with a fist. A biomechanics expert demonstrated that a single blow with a fist to the rigidly supported head of the victim could generate the required force to produce the observed fractures. The previous medical condition possibly predisposed the victim to the cranial fractures and contributed to the depressed nature of the fractures. Although depressed cranial fractures do not typically result from a blow with a fist, it was determined in this case that the fracture pattern was consistent with a punch to the head.
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ranking = 158.89329789063
keywords = skull fracture, fracture, skull
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