Immediate bone replacement in compound depressed skull fractures

Twelve patients with compound depressed skull fractures whose post-debridement cranial defects were treated with immediate bone replacement (IBR) are described. All were fully conscious on admission and except one who had debridement two days after injury, all had surgery within 24 hours of wounding. None had post-operative wound infection or osteomyelitis of the replaced bone fragment. Four patients with severe or moderately severe head wounds had the comminuted free fragments removed without replacement. Primary repair of skull defects with bone fragments is recommended as the treatment of choice during debridement of compound depressed skull fractures of mild to moderate severity which present in hospital within 24 hours of injury.