Citation

Agrawal A, Kumar SS, Reddy UV, Hegde KV, Subrahmanyan BV. Int. J. Crit. Illn. Inj. Sci. 2015; 5(4): 227-229.

Affiliation

Department of Forensic Medicine, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India.

Copyright

(Copyright © 2015, Medknow Publications)

DOI

10.4103/2229-5151.170842

PMID

26807389

PMCID

PMC4705566

Abstract

In majority of the cases, a depressed fracture is characterized by in driven fractured bone fragments. In contrast to this, in cases of "elevated skull fracture" due to tangential direction of the mechanical force, the bone fragment is elevated above the level of the intact skull. A 61-year-old gentleman presented with the history of stumble hit against the rail coach door. He was unconscious since the time of injury. There was no history of loss of seizures; vomiting; and ear, nasal, or oral bleed. There was an open wound from which he was profusely bleeding and brain matter was coming out. On examination, the pulse rate was 110/min. The patient was in altered sensorium and he was intubated to secure the airway. Glasgow Coma Scale (GCS) was E2V2M5. Pupils were bilateral equal and reacting to light. The patient was moving all four limbs equally. Local examination revealed a large scalp laceration with active bleeding and the brain matter was coming out from the wound. After hemodynamic stabilization, the patient underwent plain computed tomography (CT) brain with bone window. It showed compound elevated fracture of the frontal bone with underlying contusion and cerebral edema. The patient was taken for emergency surgery. Scalp laceration was extended on either side and fracture bone flap was delivered from the wound. The wound was irrigated thoroughly with normal saline. Contused brain tissue was evacuated and a lax duroplasty was performed. Bone flap was thoroughly washed with povidone–iodine and hydrogen peroxide, and was replaced. The patient was kept on elective ventilation. He was weaned off successfully and made a gradual recovery over a period of 10 days. He was discharged without neurological deficits.

Language: en