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Clinical and imaging characteristics of growing skull fractures in children
Qingshuang Zhao1, Jianbin Ying1,2, Yehuang Chen2
1Department of Neurosurgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, People's Republic of China.
Insights
A new classification system for growing skull fractures (GSF) in children aids diagnosis and treatment. This GSF classification, based on clinical and imaging data, helps predict outcomes and improve prognosis.
Area of Science:
- Pediatric Traumatology
- Pediatric Neurosurgery
- Pediatric Radiology
Background:
- Growing skull fracture (GSF) is a rare pediatric head injury.
- Existing GSF classifications lack clinical utility due to varying trauma severity and admission times.
- A need exists for a classification system integrating clinical and imaging findings for better diagnosis and treatment guidance.
Purpose of the Study:
- To develop a clinically useful classification system for pediatric growing skull fractures.
- To correlate GSF types with clinical presentations and imaging characteristics.
- To guide clinical diagnosis, treatment decisions, and improve patient prognosis.
Main Methods:
- Retrospective collection of clinical and imaging data from 23 pediatric patients (<12 years) with GSF.
- Classification of GSF into four distinct types based on clinical and imaging features.
- Statistical analysis of characteristics across different GSF types.
Main Results:
- GSF predominantly affects children under 3 years (91.3%).
- Types I-III commonly present with younger age and subscalp masses; Types II-IV show wider fractures (≥4mm); Types III-IV exhibit neurological dysfunction.
- Type IV GSFs display 'crater-like' changes and do not improve; other types show functional improvement with treatment.
Conclusions:
- The proposed four-type GSF classification system effectively correlates with distinct clinical and imaging characteristics.
- This classification aids in early diagnosis and targeted treatment of pediatric growing skull fractures.
- Implementing this system can significantly improve patient prognosis.
Abstract:
Growing skull fracture (GSF) is an uncommon form of head trauma among young children. In prior research, the majority of GSFs were typically classified based on pathophysiological mechanisms or the duration following injury. However, considering the varying severity of initial trauma and the disparities in the time elapsed between injury and hospital admission among patients, our objective was to devise a clinically useful classification system for GSFs among children, grounded in both clinical presentations and imaging findings, in order to guide clinical diagnosis and treatment decisions. The clinical and imaging data of 23 patients less than 12 years who underwent GSF were retrospectively collected and classified into four types. The clinical and imaging characteristics of the different types were reviewed in detail and statistically analyzed. In all 23 patients, 5 in type I, 7 in type II, 8 in type III, and 3 in type IV. 21/23 (91.3%) were younger than 3 years. Age ≤ 3 years and subscalp fluctuating mass were common in type I-III (P = 0.026, P = 0.005). Fracture width ≥ 4 mm was more common in type II-IV (P = 0.003), while neurological dysfunction mostly occurred in type III and IV (P < 0.001).Skull "crater-like" changes were existed in all type IV. 10/12 (83.3%) patients with neurological dysfunction had improved in motor or linguistic function. There was not improved in patients with type IV. GCS in different stage has its unique clinical and imaging characteristics. This classification could help early diagnosis and treatment for GCS, also could improve the prognosis significantly.
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