Related Experiment Video
Updated: Sep 27, 2025
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Compound elevated skull fractures: a retrospective descriptive study
Prashanth Maharaj1, Basil Enicker1
1Department of Neurosurgery, University of Kwa Zulu Natal, Durban, South Africa.
Background:
Traumatic skull fractures have been traditionally classified into those that involve the base or vault with distinct entities linear or depressed. Compound elevated skull fracture is a newer entity with scanty reports in the literature.
Objective:
To describe the clinical presentation, neuro-radiology findings by development of a classification system, medical and surgical management, and complications of patients with compound elevated skull fractures at a tertiary referral neurosurgical department.
Methods:
Medical records of consecutive patients admitted from January 2005 to December 2018 with compound elevated skull fractures at the single neurosurgical referral hospital were retrospectively evaluated. Data was analyzed for demographics, clinical presentation, mechanisms of injury, neuro-radiology findings, management and outcomes.
Results:
Eighteen patients were included in this series with a median age of 28 years, median admission Glasgow Coma Scale was 12. Ten patients presented with focal neurological deficits which included hemiparesis [n = 8, 44%] and unilateral afferent pupil deficit [n = 2, 11%]. Intra-cerebral haematoma was the most common associated neuro-radiological finding [n = 10, 55%] followed by acute extradural haematoma [n = 4, 22%]. Three distinct neuro-radiological subtypes were identified: Type 1 - fractured segment with minimal loss of contact with rest of cranial vault, Type 2 - fractured segment with partial loss of contact with rest of cranial vault, Type 3 - fractured segment with complete loss of contact with rest of cranial vault. All patients underwent surgical debridement and of which 11 [61%] required duroplasty and 10[55%] re-placement of elevated bone flap. Septic complications included meningitis [n = 5, 27%], brain abscess [2, 11%] and surgical site infection [n = 1, 5%]. Seventeen patients had favourable outcomes at discharge (Glasgow Outcome Scale 4 or 5).
Conclusion:
Compound elevated skull fracture is an additional subtype of skull vault fracture. Prompt neurosurgical management with appropriate operative management of dura and elevated bone fragment reduces morbidity from septic complications.
Related Concept Videos
01:14Cranial Bones: Superior and Posterior View
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
01:08Overview of the Skull
The cranial vault surrounds and protects the brain and houses the middle and inner ear structures. This cavity is bounded superiorly by the rounded top of the skull, which...