Rupture or traumatic dislocation of cranial suture on infants, involvement of the lambdoidal accessory bones (Wormian...

Sutural or Wormian bones are accessory bones of genetic and hereditary relevance, considered as ethnic and anatomical variables. Recently, they have been related to a certain type of congenital alterations such as osteogenesis imperfecta; however, there is no description in the literature of their involvement in skull fractures in infants.

We present a case of a male patient aged 15 months who suffered a fall from the stairs of his home approximately 6 h before arrival in the emergency room. This fall of approximately 1 m in height and with an area of direct impact on the right occipito-parietal region with no apparent loss of consciousness. At admission, with a Glasgow of 14 for irritability with subgaleal hematoma and cranial endostosis on occipitoparietal region, no more neurological signs were present. A CT scan of the skull was performed showing an occipital-parietal discontinuity at the lambdoid suture, and the scan also showed that a displacement occurred below the thickness of the adjacent bone. In addition, radiographic evidence showed a high possibility of dural penetration and an area of adjacent hemorrhagic contusion. Due to these findings, a surgical approach was decided upon. The findings in the surgical procedure were a complete dislocation (rupture) of lambdoidal cranial suture on the occipital border of the accessory bone (Wormian bone) with dura mater tear on the rupture tracing. A craniotomy was performed with dural plasty without eventualities. Forty-eight hours after surgery, he was discharged home in a stable neurologic condition.

The present report shows the implications of approaching this type of injury, which can be confused as a depressed skull fracture. There is no description in the literature of a sutural rupture associated with Wormian bones.