Skull Fracture Guidelines

Updated: Sep 27, 2018
  • Author: Nazer H Qureshi, MD; Chief Editor: Brian H Kopell, MD  more...
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Guidelines Summary

The American Colllege of Radiology Appropriateness Criteria for head trauma includes the following [8, 9] :

  • Skull radiography has been supplanted by CT in characterizing skull fractures in the setting of acute traumatic brain injury, though it may be useful in limited circumstances, such as radiopaque foreign bodies.

  • Contrast-enhanced MRI or CT may be helpful if posttraumatic infection is clinically suspected in patients with risk factors such as skull base fractures.

  • Traumatic dural sinus thrombosis is most commonly seen in patients with skull fractures that extend to a dural venous sinus or the jugular foramen.

  • Cerebrospinal fluid leak occurs in 10-30% of skull base fractures and most often presents with rhinorrhea (80% of cases) in the setting of frontobasal fracture.

  • In children, radiographs of the skull are known to have a low predictive value in determining intracranial injury. However, in contrast to accidental head trauma, where radiographs have largely been replaced by CT, skull radiographs are still often performed as part of the skeletal survey in evaluation of suspected nonaccidental trauma. It has been generally accepted that skull radiographs and head CT are complementary examinations, since fractures in the plane of the transaxial CT image may not be apparent on the head CT examination.