DOI: http://dx.doi.org/10.18203/2349-2902.isj20181586

Primary reconstruction of depressed skull fracture

Arshad Khan, Nishant Shrivastava, S. S. Pal

Abstract


Background: Depressed fracture poses a specific challenge to neurosurgeon. Aim of our study is to analyze benefits of primary reconstruction of depressed skull fracture and to compare various methods of fracture reconstruction with that of titanium miniplates The concept of primary reconstruction was to close the defect and preserve the anatomical barrier, to avoid later crainoplasty and to prevent further complications like CSF leak, pneumocephalus, brain fungus and meningitis etc. The second reason for rigid fixation was to achieve good cosmetic results.

Methods: This is observational study carried out in Department of General Surgery, Hamidia hospital Bhopal on 36 patients over period of 18 months from January, 2016 to July, 2017.

Results: : Depressed skull fracture is more prevalent in second and third decade of life with male to female ratio of 5:1 . Most of the patients (72%) presented with open fracture skull and majority of them (89%) presented with underlying brain injury. Out of total 36 patients of depressed fracture skull, 18 patients (50%) underwent fixation with titanium miniplate and rest underwent fixation with nylon suture, Poly-L-Lactide and primary elevation of depressed skull fracture. The correction of deformity was more than 90% compared to contralateral side and better cosmetic results were obtained on patients treated with titanium mini-plates. Post operative infection rate was nil in patient treated with titanium mini-plates compared to 8.2% of total infection rates in patients treated with other methods.

Conclusions: The concept of primary reconstruction of depressed skull fracture to achieve better cosmetic results and minimum post operative complications. Cosmetic results that were obtained with titanium mini-plates were excellent with nil post operative infection rates and complete neurological recovery. Hence titanium mini-plates are cost effective and better than any other methods.


Keywords


Head injury, Depressed fracture, Primary reconstruction, Titanium miniplate

Full Text:

PDF

References


Singh J, Stock A. Head Trauma. 2006. Available at http://enacademic.com/dic.nsf/enwiki/1226329#cite_note-singh-1. Retrieved on January 26, 2007.

Cooper PR. Skull fracture and traumatic cerebrospinal fluid fistulas. In Cooper PR (Ed): Head injury, 3rd ed. Baltimore: Williams and Wilkins;1993:115-136.

Vollmer DG, Dacey R G, Jane JA. Cranio-cerebral-trauma. In Joynt RJ (Ed): Clinical Neurology. Philadelphia: Lippincott;1991;3:1-79.

Gade GF, BeckerDP, Miller JD, et al. Pathology and pathophysiology of head injury. In Youmans JR (Ed): Neurological Surgery, 3rd ed. Philadelphia: Saunders;1990:1965-2016

Lang J. Skull base and related structures: atlas of clinical anatomy. F. K. Schattauer, Germany;1999:208.

Mottaran R, Guarda-Nardini L, Fusetti S, Ferroneto G. Reconstruction of a large post-traumatic cranial defect with a customized titanium plaque. J Neurosurg Sci. 2004 Sep 1;48(3):143.

Kuttenberger JJ, Hardt N. Long-term results following reconstruction of craniofacial defects with titanium micro – mesh systems. J Craniomaxillofac Surg. 2001;29:75-81.

Jennett B Miller JD. Infection after depressed fracture of skull, implications for management of non-missile injuries. J Neurosurg. 1972;36:333.

Setsuko N, Masamitsu A, Takehisa T. Cranioplasty using titanium miniplates for the repair of a comminuted fracture: Report of two cases. Japan J Neurosurg. 1994;3:259-62.

Qureshi NH. Skull fracture, E- medicine update: April 13 2006. Available at https://emedicine.medscape.com/article/248108-overview. Online assessed on 12 dec 2007.

Stendel R. Krischek B, Pietila TA. Biodegradable implants in neurosurgery. Acta Neurochir (wien). 2001;143:237-43.