Skull Fracture

What is a skull fracture?

A skull fracture is a break in the bone structure that surrounds your brain. It’s a type of head injury. Most skull fractures are the result of a blow (impact) to the head.

Most skull fractures are minor and don’t require surgery. However, you should still call 911 or your local emergency services number if you experience a head injury. Some head injuries are life-threatening and require quick treatment for the best outcome.

If the injury affects your brain, you may need surgery to treat it. Some skull fractures heal without treatment, but a healthcare provider will monitor the fracture to make sure there aren’t complications.

What are the types of skull fractures?

There are several types of skull fractures, including:

• Linear fracture: This is the most common type of skull fracture. It usually happens in the bone toward the top of your head, above your ears.
• Depressed fracture: A break in your skull that pushes part of the bone closer to your brain. A depressed fracture can involve multiple cracks and fragments.
• Basal (basilar) fracture: A break of the bones at the base of your skull. This includes the bones behind your face and the bones that are internal in your brain that you can’t see.
• Diastatic fracture: A separation of the cranial sutures, or the bands of tissue that connect the bones in your skull together.
• Combination or complex fractures: Fractures that may involve several of the above types or multiple areas of fractured bone.

Another important way to identify the types of skull fractures relates to the skin (scalp) over the fracture:

• Closed fracture: The injury didn’t break the skin over the fracture. This is the most common.
• Open fracture: The injury broke the skin over the fracture. This type of injury has a higher risk of infection.

How common are skull fractures?

The exact rate of occurrence of skull fractures is unknown. Each year, more than 2.5 million emergency department visits occur in the United States for traumatic brain injuries (including skull fractures).

What are the signs of a skull fracture?

Signs of a skull fracture vary based on what type of fracture and where the break occurred, but could include:

• Skin color changes (darkening or redness) at the injury site.
• Swelling or a bump or lump on your head.
• Bruising around the injury, your eyes (raccoon eyes) or behind your ears (battle sign).
• Clear fluid (cerebrospinal fluid) leaks from your nose or ears.
• Blood draining from your nose, ear or a wound at the site of an open fracture.

What are the symptoms of a skull fracture?

One of the first symptoms of a skull fracture is pain from the impact of the injury. Most people with a head injury experience pain.

If the injury affects your brain, you may experience the following:

• Nausea and vomiting.
• Confusion.
• Trouble with speech (slurred speech).
• Vision loss.
• Loss of feeling in parts of your body.
• Difficulty with balance and coordination.
• Fatigue.

What causes a skull fracture?

Skull fractures happen when there’s so much force applied to a bone that it must break. Common ways that a skull fracture can happen include:

• Impact injury (something hits your head or your head hits something).
• Falls.
• Motor vehicle accidents.
• Sports injuries.
• Personal violence.

What are the risk factors for a skull fracture?

Skull fractures are more common among children due to their skulls being thinner and more fragile than those of full-grown adults. Adults over the age of 75 are also at a higher risk of skull fractures because of more frequent falls. You may be more likely to get a skull fracture if you participate in high-risk activities like contact sports.

What are the complications associated with a skull fracture?

Complications of skull fractures may include:

• Bleeding in brain tissue (intracranial hemorrhage).
• Brain damage, including bruised brain tissue (contusion).
• Blood clots (venous sinus thrombosis).
• Changes to your appearance.
• Infection (meningitis).
• Paralysis.
• Seizures.

Skull fracture complications can be life-threatening.

How is a skull fracture diagnosed?

A healthcare provider will diagnose a skull fracture, usually in an emergency department, following a physical exam and an imaging test like a CT (computed tomography) scan. A CT scan will help your provider see the bones in your skull. A neurological exam will help your provider learn more about how the injury affects your brain. Occasionally, an MRI may also be helpful.

How is a skull fracture treated?

Most skull fractures don’t require any significant medical treatment except treatment related to any head injuries. However, your healthcare provider may recommend you stay in a hospital for a short period following a fracture for observation.

There isn’t a specific treatment for a linear fracture, and it should heal on its own. While in the hospital, your care team will observe you for complications like seizures. If you do have seizures, a healthcare provider will treat those with antiseizure medication.

Short-term use of pain medication may help you feel better after an injury. Sometimes, treatment with acetaminophen is enough to ease your symptoms. Ask your healthcare provider about what type of over-the-counter pain reliever is best for you. If you experience swelling, ice also helps a lot.

Treatment for basal, depressed and diastatic fractures varies based on the severity of your injury but may include:

• Resting with head elevation (lie down with your back and head propped up on pillows).
• Draining excess or leaking cerebrospinal fluid (a healthcare provider will insert a small needle in your lower back).
• Having surgery to repair the skull bones, move them back into place and stitch (suture) your skin together over the injury for open fractures.

How long does it take to recover from a skull fracture?

The healing time for a skull fracture varies based on the type and severity of your injury. It could take several weeks to months for your bones to heal completely.

Can a skull fracture be prevented?

You can’t prevent all skull fractures, but you can take steps to protect yourself from injury by wearing:

• Protective equipment when playing sports or participating in high-risk activities.
• A seatbelt when in a vehicle.
• A helmet when riding a motorcycle, ATV/UTV or bicycle.

What can I expect after a skull fracture?

A skull fracture needs close monitoring to prevent complications. Your healthcare provider will give you specific instructions to take care of yourself. This could include resting in an upright position, changing wound dressings and avoiding blowing your nose if you injure your sinus.

Avoid strenuous activities while your skull heals. Following your healthcare provider’s instructions helps you heal faster and feel better sooner.

Reconstructive surgery may help you feel more confident after an injury if you experience a depressed fracture or an injury that affects your appearance.

Complications are rare but possible after a skull fracture, especially if the fracture injured your brain.

What’s the outlook for a skull fracture?

Your outlook after a skull fracture varies based on the severity of your injury, your age and your general health. Most people make a full recovery after a skull fracture. It’s rare to experience long-term complications.

Among children, approximately 80% to 90% of reported head injuries are mild. Skull fractures that are life-threatening or require surgery are less common.

Your healthcare provider can give you the most accurate information about your outlook.

When should I go to the ER?

Contact 911 or emergency services if you experience a head injury. Get help right away if you:

• Are bleeding and/or fluid drains from your nose and ears.
• Feel confused or disoriented.
• Have trouble staying awake.
• Experience a severe headache.

What questions should I ask my healthcare provider?

• What type of skull fracture do I have?
• What type of pain reliever can I take?
• Do I need surgery?
• Do I need to stay in the hospital for observation?
• How do I take care of myself when I go home?