Skull fracture (peds)

Background

• Predictor of intracranial injury
• Infants are at higher risk due to thinner calvarium
• Most skull fractures have overlying hematoma

Differential Diagnosis

Maxillofacial Trauma

• Le Fort fractures
• Skull fracture (peds)
• Auricular hematoma
• Nasal fracture
  • Nasal septal hematoma
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Dental trauma
• Mandible fracture

Orbital trauma

Acute

• Ruptured Globe^
• Corneal Abrasion
• Ocular foreign body
• Conjunctival laceration
• Caustic Keratoconjunctivitis^^
• Subconjunctival hemorrhage
• Traumatic iritis
• Traumatic hyphema
• Retinal detachment
• Retrobulbar hemorrhage/hematoma
• Traumatic mydriasis
• Orbital fracture
  • Frontal sinus fracture
  • Naso-ethmoid fracture
  • Inferior orbial wall fracture
  • Medial orbital wall fracture

Subacute/Delayed

• Endophthalmitis^
• Corneal Ulcer^

Evaluation

• Head CT

Management

• Antibiotics indicated for:
  • Open fracture
  • Depressed fracture
  • Involves sinus
  • Leads to pneumocephalus
• Ceftriaxone 2gm IV + metronidazole 500mg +/- vancomycin 1gm IV

See Also

• Head Trauma

References

Authors

Ross Donaldson, Nicole Zadzilka, Michael Holtz, Neil Young, Claire, Daniel Ostermayer