Skull Fracture Workup

  • Author: Nazer H Qureshi, MD; Chief Editor: Allen R Wyler, MD   more...
 
Updated: Jan 13, 2012
 

Laboratory Studies

In addition to a complete neurological examination, baseline laboratory analyses, and tetanus toxoid (where appropriate, as in open skull fractures), the diagnostic workup for fractures is radiological.

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Imaging Studies

  • Radiographs: In 1987, the skull x-ray referral criteria panel decided that skull films are suboptimal in revealing basilar skull fractures. Hence, other than a fracture at the vertex that might be missed by CT scan and picked up by a plain film, skull x-ray is of no benefit when a CT scan is obtained.
  • CT scan: CT scan is the criterion standard modality for aiding in the diagnosis of skull fractures. Thinly sliced bone windows of up to 1-1.5 mm thick, with sagittal reconstruction, are useful in assessing injuries. Helical CT scan is helpful in occipital condylar fractures, but 3-dimensional reconstruction usually is not necessary.[20]
  • MRI: MRI or magnetic resonance angiography is of ancillary value for suspected ligamentous and vascular injuries. Bony injuries are far better visualized using CT scan.
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Other Tests

Bleeding from the ear or nose in cases of suspected CSF leak, when dabbed on a tissue paper, shows a clear ring of wet tissue beyond the blood stain, called a "halo" or "ring" sign. A CSF leak can also be revealed by analyzing the glucose level and by measuring tau-transferrin.

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Contributor Information and Disclosures
Author

Nazer H Qureshi, MD  Chief of Brain and Spine Tumor Service, Baptist Health System, North Little Rock

Nazer H Qureshi, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, Congress of Neurological Surgeons, and World Society for Stereotactic and Functional Neurosurgery

Disclosure: NMT Inc. None Consulting

Coauthor(s)

Griffith Harsh IV, MD  Professor, Director of Neurosurgical Oncology, Department of Neurosurgery, Stanford Medical Center, Stanford University School of Medicine

Griffith Harsh IV, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, California Medical Association, Neurosurgical Society of America, North American Skull Base Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael G Nosko, MD, PhD  Associate Professor of Surgery, Chief, Division of Neurosurgery, Medical Director, Neuroscience Unit, Medical Director, Neurosurgical Intensive Care Unit, Director, Neurovascular Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School

Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, Canadian Congress of Neurological Sciences, Congress of Neurological Surgeons, New York Academy of Sciences, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Allen R Wyler, MD  Former Medical Director, Northstar Neuroscience, Inc

Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD  Former Medical Director, Northstar Neuroscience, Inc

Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons

Disclosure: Nothing to disclose.

References

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Classification of skull fractures
Transverse temporal bone fracture (courtesy of Adam Flanders, MD, Thomas Jefferson University, Philadelphia, Pennsylvania)
Longitudinal temporal bone fracture (courtesy of Adam Flanders, MD, Thomas Jefferson University, Philadelphia, Pennsylvania)
Depressed skull fracture (courtesy of Adam Flanders, MD, Thomas Jefferson University, Philadelphia, Pennsylvania)
Table 1. Differences Between Skull Fractures and Sutures
FracturesSutures
  • Greater than 3 mm in width
  • Widest at the center and narrow at the ends
  • Runs through both the outer and the inner lamina of bone, hence appears darker
  • Usually over temporoparietal area
  • Usually runs in a straight line
  • Angular turns
  • Less than 2 mm in width
  • Same width throughout
  • Lighter on x-rays compared with fracture lines
  • At specific anatomic sites
  • Does not run in a straight line
  • Curvaceous
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