Basilar skull fracture; Depressed skull fracture; Linear skull fracture
Skull fractures may occur with head injuries. Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull. It may be accompanied by injury to the brain.
The brain can be affected directly by damage to the nervous system tissue and bleeding. The brain can also be affected indirectly by blood clots that form under the skull and then compress the underlying brain tissue (subdural or epidural hematoma).
A simple fracture is a break in the bone without damage to the skin.
A linear skull fracture is a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone.
A depressed skull fracture is a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brain.
A compound fracture involves a break in, or loss of, skin and splintering of the bone.
Falls, automobile accidents, physical assault, and sports
Bleeding from wound, ears, nose, or around eyes
Bruising behind the ears or under the eyes
Changes in pupils (sizes unequal, not reactive to light)
Difficulties with balance
Drainage of clear or bloody fluid from ears or nose
Loss of consciousness
Note: The only symptom may be a bump on the head. A bump or bruise may take up to 24 hours to develop.
1. Check the airways, breathing, and circulation. If necessary, begin rescue breathing and CPR.
2. Avoid moving the victim (unless absolutely necessary) until medical help arrives. Instruct someone to call 911 (or the local emergency number) for medical assistance.
3. If the victim must be moved, take care to stabilize the head and neck. Place your hands on both sides of the head and under the shoulders. Do not allow the head to bend forward or backward, or to twist or turn.
4. Carefully check the site of injury, but do not probe in or around the site with a foreign object. It can be difficult to know if the skull is fractured or depressed (dented in) at the site of injury.
5. If there is bleeding, apply firm pressure with a clean cloth to control blood loss over a broad area.
6. If blood soaks through, do not remove the original cloth. Instead, apply additional cloths on top, and continue to apply pressure.
7. If the victim is vomiting, stabilize the head and neck (as outlined in number 3, above), and carefully turn the victim to the side to prevent choking on vomit.
8. If the victim is conscious and experiencing any of the previously listed symptoms, transport to the nearest emergency medical facility (even if the patient does not think medical assistance is necessary).
Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.