Frontal Fracture Workup

  • Author: Thomas Widell, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Nov 17, 2011
 

Laboratory Studies

  • Direct lab studies toward workup of trauma patient.
  • If fracture is an isolated injury, obtain preoperative labs if surgery is planned.
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Imaging Studies

  • Radiographs
    • Obtain routine facial views, including Waters, Caldwell, and lateral projections.
    • Caldwell projection provides the best view of the anterior table; however, the posterior table is difficult to assess in any of the standard plain film views.
  • CT scan
    • Frontal sinus fractures usually require CT scan, examining bone windows to evaluate the posterior table of the frontal sinus.
    • Look for associated orbital rim and nasoethmoidal fractures on CT scan.
    • Consider brain CT scan to exclude brain injuries or intracranial bleeds.
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Other Tests

  • Test clear rhinorrhea for glucose to help determine if it is CSF, as nasal secretions are normally low in glucose.
  • If blood is present, this test is unreliable.
  • Blood-tinged fluid can be placed on filter paper to look for a double ring sign of CSF around blood; however, this is not reliable.
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Procedures

  • When dural leak causing CSF rhinorrhea is suspected yet cannot be proven, the following procedure, which is generally not performed in the emergency department, may be done. Inject fluorescein dye into the lumbar subarachnoid space. Examine the discharged nasal fluid 30 minutes later with a Wood lamp for fluorescence; fluorescence confirms CSF rhinorrhea.
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Contributor Information and Disclosures
Author

Thomas Widell, MD  Vice Chairman, Assistant Professor, Department of Emergency Medicine, Rosalind Franklin School of Medicine/The Chicago Medical School, North Chicago, Illinois; Associate Residency Director, University of Chicago Emergency Medicine Program, Chicago, Illinois; Program Director Emergency Medical Education, Attending Physician, Mount Sinai Hospital Medical Center, Chicago, Illinois

Disclosure: Nothing to disclose.

Specialty Editor Board

Francis Counselman, MD, FACEP  Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency 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

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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