Skull fractures and brain injury

Content
Anatomy of the skull
Skull fractures
Anatomy of the meninges and spaces
Intracranial Haemorrhages
Injury to the brain and brainstem
 Anatomy of the skull
The skull has 22 bones, excluding the ossicles
of the ear.
The bones of the skull are attached to each
other by sutures which are immobile and
together form the cranium.
The cranium can be subdivided into:

The calvaria, which surrounds the cranial cavity

containing the brain.
Facial bones.
Calvaria
The calvaria is the dome-shaped roof that protects
the superior aspect of the brain. It consists of the
frontal bone, the paired parietal bones and temporal
bones, the occipital bone, the ethmoid and the
sphenoid bone.
Sutures visible internally include:
1. The coronal suture, between the frontal and
parietal bones;
2. The sagittal suture, between the paired parietal
bones;
3. The lambdoid suture, between the parietal and
occipital bones.
Calvaria
FLOOR

The floor of the cranial cavity is divided into

anterior, middle and posterior cranial fossae.
 The Anterior Cranial Fossa consists of parts of
the frontal, ethmoid and sphenoid bones.
 The Middle Cranial Fossa consists of parts of
the sphenoid and temporal bones.
 The Posterior Cranial Fossa consists mostly of
parts of the temporal and occipital bones with
small contributions from the sphenoid and
parietal bones.

It is the largest and deepest of the three

cranial fossae and contains the brainstem
(midbrain, pons, and medulla) and the
cerebellum.
Post cranial fossa
Adult skull consists of two parallel thin tables of
compact bone
The outer table thicker and stronger
The inner table.

Both separated by soft cancellous (spongy)

bone. Also called as diploe.

This diploe starts forming at the age of 4 years

before this age it is thin and elastic.
Skull with compact and spongy layers
 The temporal bone is the thinnest with a
thickness of 4 mm.
The frontal and the parietal bones are
about 6-10 mm in thickness.
The occipital bone is the thickest in the
midline being more than or equal to
15mm.
Strong parts of the cranium are
Greater wing of sphenoid

Sagittal ridge

Occipital protuberance

Glabella

The thin areas of the cranium are

Parieto-temporal area

Lateral parts of the frontal bone

Lateral parts of the occipital bone

 Fetal skull
The skull consists of the fibrous membrane
that becomes ossified through a process of
cellular differentiation.
In infancy the bones of skull are thin and
pliable, the differentiation between inner and
outer is hardly seen.
Fetal skull pic
 Patency of fontanelles gives protection to the
skull from trauma.
With closure of fontanelles and union of the
sutures, the skull becomes the rigid cavity.
CAPACITY
Fetal skull > 350ml,
Adult skull > 1400-1500ml.
Base of the skull have Jagged areas.
CLASSIFICATION OF HEAD INJURY
If the dura is lacerated ( bullet or any other
object) it is called an open head injury
because it is open to infections.
If the dura remains intact it is called a closed
head injury, whether the skull is fractured or
not. Caused by blunt force to the head.
Depending on the duration of
unconsciousness and glasgow coma scale:
mild, moderate and severe head injury.
 GLASGOW COMA SCALE
1. EYE OPENING (E);
Spontaneous=4, to voice=3, to pain=2, None=1
2. VERBRAL RESPONSE(V);
Oriented=5, confused=4, inappropriate word=3,
incomprehensive sounds=2, None=1
3. MOTOR RESPONSE (M);
Obeys command=6, localize pain=5, withdraw=4,
flexion=3, extension=2, None=1
13-15 (mild), 9-12 (moderate), 3-8 (severe)
 Classification of head injury
Type Duration of Glasgow coma
unconsciousness scale

Mild head injury Less than 30 mins 13 - 15

Moderate head 30 mins to 6 hours 9- 12

injury

Severe head injury More than 6 hours 3- 8

Fractures of the skull
 VIOLENCE ACTING
Fractures may be caused by direct or indirect
violence.
DIRECT VIOLENCE
Force acting directly on the bone producing a

fracture.
head getting crushed under the wheel of a
moving vehicle in RTA.
Fall from height onto the head.
An object in motion striking the head.