Management of bone fragments in nonmissile compound depressed skull fractures

There is no settled standard of care or even a consensus between neurosurgeons on the replacement of bone fragments in compound depressed skull fractures (CDSF).

This cohort study retrospectively reviewed the patients with nonmissile CDSF who were admitted to our university hospitals from January 2010 to January 2015. Patients who were managed nonoperatively, polytrauma, comatose patients, and CDSF over the air sinuses were excluded from this study.

This study includes 87 consecutive patients with nonmissile CDSF who were surgically treated from January 2010 to January 2015. Follow-up varied from 12 to 36 months. All of the 87 patients presented within 1 week after injury; 76 patients (87.35 %) had surgery within the first 72 h of trauma, and these patients had primary bone fragment replacement (after decontamination) with or without miniplates and minimesh. The patients who presented after 72 h of trauma with no wound discharge had their bone fragments autoclaved then replaced. The patients who presented after 72 h of trauma and had pus or serous discharge from the wound had their bone fragments discarded and scheduled for delayed cranioplasty. The long-term infection rate in all patients who had a primary bone fragment replacement in this study is 0 %.

Primary bone fragment replacement (after decontamination) is a safe option in the management of nonmissile CDSF within 72 h of trauma in selected patients.