• Gul Muhammad Department of Neurosurgery, Ayub Medical College Abbottabad
  • Ahsan Aurangzeb Department of Neurosurgery, Ayub Medical College Abbottabad
  • Shahbaz Ali Khan Department of Neurosurgery, Ayub Medical College Abbottabad
  • Rao Suhail
  • Iqbal Hussain Department of Neurosurgery, Ayub Medical College Abbottabad
  • Sudhair Alam Department of Neurosurgery, Ayub Medical College Abbottabad
  • Ehtisham Ahmed Khan Afridi Department of Neurosurgery, Ayub Medical College Abbottabad
  • Baynazir Khan Department of Neurosurgery, Ayub Medical College Abbottabad
  • Sajid Nazir Bhatti Department of Neurosurgery, Ayub Medical College Abbottabad


Background: The presence of skull fracture in patients sustaining traumatic brain injury is an important risk factor for intracranial lesions. Assessment of integrity of dura in depressed skull fracture is of paramount importance because if dura is torn, lacerated brain matter may be present in the wound which needs proper debridement followed by water tight dural closure to prevent meningitis, cerebral abscess, and pseudomeningocoele formation. The objective of this study was to determine the frequency of dural tear in patients with depressed skull fractures. Methods: This cross sectional study was conducted at Department of Neurosurgery Ayub Teaching Hospital Abbottabad. All the patients of either patients above 1 year of age with depressed skull fracture were included in this study in consecutive manner. Patients were operated for skull fractures and per-operatively dura in the region of depressed skull fracture was closely observed for any dural tear. The data were collected on a predesigned pro forma. Results: A total of 83 patients were included in this study out of which 57 (68.7%) were males and 26 (31.3%) were females. The age of the patients ranged from 1-50 (mean 15.71±13.49 years). Most common site of depressed skull fracture was parietal 32 (38.6%), followed by Frontal in 24 (28.9%), 21(25.3%) in temporal region, 5(6.0%) were in occipital region and only 1 (1.2%) in posterior fossa. Dural tear was present in 28 (33.7%) patients and it was absent in 55 (66.3%) of patients. Conclusion: In depressed skull fractures there are high chances of associated traumatic dural tears which should be vigilantly managed.Keywords: Depressed skull fracture, Dural tear, Head injury, trauma, elevation of depressed fracture, extradural hematoma, brain contusion.


Hoyt DB, Holcomb J, Abraham E, Atkins J, Sopko G. Working Group on Trauma Research Program summary report: National Heart Lung Blood Institute (NHLBI), National Institute of General Medical Sciences (NIGMS), and National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH), and the Department of Defense (DOD). J Trauma 2004;57(2):410–5.

Greenwald RM, Gwin JT, Chu JJ, Crisco JJ. Head impact severity measures for evaluating mild traumatic brain injury risk exposure. Neurosurgery 2008;62(4):789–98.

Shukla D, Devi BI. Mild traumatic brain injuries in adults. J Neurosci Rural Pract 2010;1(2):82–8.

Rastogi D, Meena S, Sharma V, Singh GK. Epidemiology of patients admitted to a major trauma centre in northern India. Chin J Traumatol 2014;17(2):103–7.

Umerani MS, Abbas A, Sharif S. Traumatic brain injuries: experience from a tertiary care centre in Pakistan. Turk Neurosurg 2013;24(1):19–24.

Raja IA, Vohra AH, Ahmed M. Neurotrauma in Pakistan. World J Surg 2001;25(9):1230–7.

Jooma R, Ahmed S, Zarden AM. Comparison of two surveys of head injured patients presenting during a calendar year to an urban medical centre 32 years apart. J Pak Med Assoc 2005;55(12):530–2.

Nayak PK, Mahapatra AK. Primary reconstruction of depressed skull fracture—The changing scenario. Indian J Neurotrauma 2008;5(1):35–8.

Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of depressed cranial fractures. Neurosurgery 2006;58(3):2–56.

Hung CC, Chiu WT, Lee LS, Lin LS, Shih CJ. Risk factors predicting surgically significant intracranial hematomas in patients with head injuries. J Formos Med Assoc 1996;95(4):294–7.

Rodriguez ED, Stanwix MG, Nam AJ, St Hiaire H, Simmons OP, Christy MR, et al. Twenty-six–year experience treating frontal sinus fractures: a novel algorithm based on anatomical fracture pattern and failure of conventional techniques. Plastic Reconstr Surg 2008;122(6):1850–66.

Tseng WC, Shih HM, Su YC, Chen HW, Hsiao KY, Chen IC. The association between skull bone fractures and outcomes in patients with severe traumatic brain injury. J Trauma 2011;71(6):1611–4.

Mehdi SA, Ahmed B, Dogar IH, Shaukat A. Depressed Skull Fracture; Interrelationship Between Ct Evaluation Of & Its Clinical Findings. Prof Med J 2010;17(4):616–22.

Head Trauma. In: Greenberg MS, Arredondo N, editors. Handbook of neurosurgery. 6th ed. Lakeland, FL : New York: Greenberg Graphics ; Thieme Medical Publishers; 2006. p.932–97.

Syed AA, Arshad A, Abida K, Minakshi S. Paraperesis: a rare complication after depressed skull fracture. Pan Afr Med J 2012;12:106.

Ali M, Ali L, Roghani IS. Surgical management of depressed skull fracture. J Postgrad Med Inst 2011;17(1):116–23.

Hossain MZ, Mondle M, Hoque MM. Depressed skull fracture: outcome of surgical treatment. J Teach Assoc 2008;21(2):140–6.

Khan AN. Imaging in Skull Fractures: Overview, Radiography, Computed Tomography [Internet]. [cited 2014 Dec 1] Available from: http://emedicine.Medscape.Com/article/343764

Belanger HG, Vanderploeg RD, Curtiss G, Warden DL. Recent neuroimaging techniques in mild traumatic brain injury. J Neuropsychiatry Clin Neurosci 2014;19(1):5–20.

Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ, Kirkpatrick PJ. Specialist neurocritical care and outcome from head injury. Intensive Care Med 2002;28(5):547–53.

Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J. A systematic review of brain injury epidemiology in Europe. Acta Neurochir 2006;148(3):255–68.

Igun GO. Predictive indices in traumatic intracranial haematomas. East Afr Med J 2000;77(1):9–12.

Yavuz MS, Asirdizer M, Cetin G, Günay Balci Y, Altinkok M. The correlation between skull fractures and intracranial lesions due to traffic accidents. Am J Forensic Med Pathol 2003;24(4):339–45.

Al-Kuwaiti A, Hefny AF, Bellou A, Eid HO, Abu-Zidan FM. Epidemiology of head injury in the United Arab Emirates. Ulus Travma Acil Cerrahi Derg 2012;18(3):213–8.

Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 2006;21(5):375–8.

Mannix R, Monuteaux MC, Schutzman SA, Meehan WP 3rd, Nigrovic LE, Neuman MI. Isolated skull fractures: trends in management in US pediatric emergency departments. Ann Emerg Med 2013;62(4):327–31.

Braakman R. Depressed skull fracture: data, treatment, and follow-up in 225 consecutive cases. J Neurol Neurosurg Psychiatry 1972;35(3):395–402.

Steinbok P, Flodmark O, Martens D, Germann ET. Management of simple depressed skull fractures in children. J Neurosurg 1987;66(4):506–10.

Ersahin Y, Mutluer S, Mirzai H, Palali I. Pediatric depressed skull fractures: analysis of 530 cases. Childs Nerv Syst 1996;12(6):323–31.

Tung GA, Kumar M, Richardson RC, Jenny C, Brown WD. Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. Pediatrics 2006;118(2):626–33.

Marbacher S, Andres RH, Fathi AR, Fandino J. Primary reconstruction of open depressed skull fractures with titanium mesh. J Craniofac Surg 2008;19(2):490–5.



Most read articles by the same author(s)

1 2 3 4 5 > >>