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Temporal bone fractures in children: a review of 34 cases
1Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, UK.
Insights
Temporal bone fractures are uncommon head injuries. Road traffic accidents and outdoor falls resulted in the poorest outcomes for patients with these fractures.
Area of Science:
- Traumatology
- Neurosurgery
- Emergency Medicine
Background:
- Head injuries frequently present to accident and emergency departments.
- Temporal bone fractures represent a subset of head injuries with significant implications.
- Understanding injury mechanisms and outcomes is crucial for patient management.
Purpose of the Study:
- To analyze the mechanisms of injury leading to temporal bone fractures.
- To evaluate the diagnostic utility of CT scans in identifying intracranial complications.
- To assess patient outcomes based on the mechanism of head injury.
Main Methods:
- Retrospective review of 34 cases with temporal bone fractures over a 7-year period.
- Analysis of injury mechanisms including falls, road traffic accidents, and other causes.
- Correlation of CT scan findings with intracranial hematomas and discussion of diagnostic criteria.
- Assessment of patient outcomes based on initial injury type.
Main Results:
- Falls (outdoors and home) and road traffic accidents were the most common injury mechanisms.
- Multiple cranial bone fractures were observed in 20 cases, raising concerns for non-accidental injury.
- CT scans in 14 cases revealed intracranial hematomas in 11 instances.
- Road traffic accident victims had the worst outcomes, followed by outdoor falls and then home falls.
Conclusions:
- Temporal bone fractures result from diverse mechanisms, with falls and RTAs being predominant.
- CT imaging is vital for detecting intracranial hematomas in suspected temporal bone fractures.
- Patient outcomes are significantly influenced by the initial mechanism of injury, with RTAs posing the highest risk.
Abstract:
Head injuries are commonly seen in accident and emergency (A&E) departments and within this group a small proportion will have a temporal bone fracture. Thirty-four such cases were identified from a 7-year period and their case notes were reviewed. The mechanisms of injury included:falls outdoors (15 cases), falls in the home (eight cases), road traffic accidents (RTAs; seven cases), missiles (three cases) and non-accidental injury (one case). In 20 cases the fracture involved more than one cranial bone, and the implications of this with regard to non-accidental injury are discussed. CT scans were carried out in 14 cases and 11 of these showed intracranial haematoma. The criteria for CT scan following head injury in general, and temporal bone fracture in particular are discussed. Outcome measures indicated that those injured as a result of RTAs had the poorest outcome, followed by those who fell outdoors and then those who fell in the home.