Linear skull fractures

The most common type of linear fractures involves a break in the bone but no displacement, and
generally no intervention is required. These fractures are usually the result of low-energy
transfer due to blunt trauma over a wide surface area of the skull. The fracture involves the
entire thickness of the skull. Generally, these fractures are of little clinical significance unless
they involve a vascular channel, a venous sinus groove, or a suture. Thus, complications
include epidural hematoma, venous sinus thrombosis, and suture diastasis.

Lateral skull radiograph in a child shows a

long, linear fracture extending from the
midline in the occipital region across the
occipital bone into the temporal bone. The
fracture is more radiolucent than the other
sutures, has no serration along its edges,
and is blind ending. At the blind end, it is
more tapered than it is at the sutural or
proximal end. There is a lack of branches.

Skull radiograph in a man shows a linear temporoparietal

fracture.

Lateral skull radiograph in a child shows a long, linear

fracture running across the occipital bone. Note its
radiolucency and straightness and the lack of branches
from it. This is not a vessel and not a known site for a
suture.
Depressed skull fractures
A fracture is clinically significant and requires elevation when a fragment of bone is depressed
deeper than the adjacent inner table. Depressed fractures may be closed or compound (open).
Compound fractures may be exposed when they are associated with a skin laceration or when
the fracture extends into the paranasal sinuses and the middle-ear structures. Depressed
fractures may require surgery to correct the deformity.

Lateral skull radiograph in a child shows an

occipital fracture. It has a sclerotic margin and is
therefore likely to be depressed. This is an
example of a non-accidental injury.

Plain radiographs of the head of a

25–year-old man who was
assaulted with a baseball bat show
a curvilinear shadow indicating a
depressed fracture.

Axial computed tomography scan demonstrates an open

comminuted and depressed frontal bone fracture with
clotted blood along the interhemispheric fissure.
Contusional hemorrhage is present in the left frontal lobe,
as is a left-sided temporal extradural hematoma containing
a small pocket of air; this finding implies an open fracture.
The temporal horns are slightly dilated, suggesting the
development of hydrocephalus.