The skull can break, or fracture, if it is subject to a direct and forceful impact. The underlying cause of a skull fracture is a head trauma that is significant enough to break at least one bone. People with a skull fracture need treating as soon as possible.
Skull fractures can vary in severity, and the extent of the injury depends on:
- the affected bone or bones
- how deep the fracture is
- whether or not the fracture also affects the skin, blood vessels, sinuses, and mucous membranes
Skull fractures can either be linear, which means that they have a single fracture line, or communicated, where multiple fracture lines are present.
It is also possible to describe fractures as either open or closed. An open fracture, also called a compound fracture, is one where there is a break in the skin or an open wound near the fracture. In a closed fracture, the bone will not penetrate the skin.
A skull fracture will always result from head trauma.
Typical injuries that cause skull fractures include:
- heavy falls
- car accidents
- sports injuries
- physical assault
Doctors classify skull fractures by how severe they are and how much additional damage the injury has caused.
The different types of skull fracture include:
- Simple fracture: Where the skull fractures without damaging the skin.
- Linear fracture: Where the fracture is one thin line with no additional lines splintering from it and no compression or distortion of the bones.
- Depressed fracture: Where the fracture causes displacement of the bone toward the brain.
- Compound fracture: Where there is a break in the skin and a splintering of the skull bone.
Some skull fractures can cause bleeding or swelling in the brain, which can compress the underlying brain tissue and result in brain damage.
The symptoms of a skull fracture may include:
- a headache or pain at the point of impact
- a bump or bruise
- bleeding from a wound
- bleeding from the ears, nose, or eyes
- clear fluid leaking from the ears or nose
- bruising behind the ears or under the eyes
- feeling drowsy, confused, or irritable
- loss of speech or slurred speech
- difficulty swallowing
- loss of balance
- impaired vision
- changes in the pupils, such as becoming dilated or not reacting to light
- becoming unconscious
- feeling sick or vomiting
- a stiff neck
- difficulty breathing
- numbness or paralysis
- a slow pulse
- ringing in the ears or difficulty hearing
- facial weakness
- loss of bowel or bladder control
As skull fractures occur as a result of severe head trauma, diagnosis tends to take place in a hospital setting.
A doctor will begin by checking the individual's cardiac and pulmonary function before giving them a thorough body examination and then carrying out a neurological exam.
They will use the Glasgow Coma Scale (GCS) to work out how severe the injury is. This form of assessment involves determining how impaired a person's consciousness is to ascertain whether or not brain damage is likely.
The doctor will also check the pupils by shining a bright light in them to see if they shrink. A dilated pupil may indicate that a large lesion has developed.
After assessing how severe a person's head injury is, the doctor will decide on the appropriate form of treatment. Some skull fractures heal by themselves while others need surgery.
First aid tips for a person with a suspected skull fracture include:
- calling 911
- checking to see if the person is breathing and, if not, starting CPR
- avoiding moving the person unless it is unavoidable
- trying to avoid moving the head and neck if safety reasons make it necessary to relocate the person
- checking the site of injury and applying firm pressure to the wound with a clean cloth if there is any bleeding
- keeping the original cloth in place if blood soaks it and applying additional ones while continuing to use firm pressure
- avoiding removing any protruding objects from the site of injury
- preventing choking if the person is vomiting by turning them on their side while keeping the head and neck stable
If the person is conscious but appears to have a skull fracture or severe head injury, someone should take them to the emergency room immediately.
It is crucial to keep a close eye on someone with a suspected skull fracture. It is also vital not to leave them alone or provide any medication without consulting a doctor first.
People who experience mild head injuries can make a full recovery and may not need treatment for their skull fracture to heal.
Moderate or severe head injuries have less favorable outcomes. An estimated 25 percent of people with moderate head injuries will retain some degree of disability.
Between 7 and 10 percent of people with a moderate head injury will remain in a permanent vegetative state or will die as a result of their injuries.
Around 33 percent of people with severe head injuries do not survive.
The outlook for a person with a skull fracture depends on the type of fracture and how severe it is.
While not all head injuries are avoidable, people can take certain measures to reduce the risk of head trauma. These include:
- wearing appropriate safety gear when taking part in sports
- wearing a helmet when riding a motorcycle or bicycle
- avoiding alcohol and wearing a seat belt when driving
In some instances, skull fractures can heal by themselves without treatment. However, more severe skull fractures may require surgery and can cause other complications, including brain damage.