Basilar skull fracture

Source: Wikipedia, the free encyclopedia.
Basilar skull fracture
Other namesBasal skull fracture, skull base fractures
head injuries[1]

A basilar skull fracture is a

cranial nerves or blood vessels.[1]

A basilar skull fracture typically requires a significant degree of trauma to occur.

Facial fractures often also occur.[1] Diagnosis is typically by CT scan.[1]

Treatment is generally based on the extent and location of the injury to structures inside the head.[1] Surgery may be performed to seal a CSF leak that does not stop, to relieve pressure on a cranial nerve or repair injury to a blood vessel.[1] Prophylactic antibiotics do not provide a clinical benefit in preventing meningitis.[2][3] A basilar skull fracture occurs in about 12% of people with a severe head injury.[1]

Signs and symptoms

Bilateral raccoon eyes

Pathophysiology

A basilar skull fracture as seen on CT
Diagram showing bones that may be involved in a basilar skull fracture

Basilar skull fractures include breaks in the

anterior skull base. The former involve the occipital bone, temporal bone, and portions of the sphenoid bone; the latter, superior portions of the sphenoid and ethmoid bones. The temporal bone fracture is encountered in 75% of all basilar skull fractures and may be longitudinal, transverse or mixed, depending on the course of the fracture line in relation to the longitudinal axis of the pyramid.[5]

Bones may be broken around the

brain stem exits and becomes the spinal cord. This may result in injury to the blood vessels and nerves exiting the foramen magnum.[6]

Due to the proximity of the

cranial nerve VIII.[4]

Management

Evidence does not support the use of preventive antibiotics, regardless of the presence of a cerebrospinal fluid leak.[3][2]

Prognosis

Non-displaced fractures usually heal without intervention. Patients with basilar skull fractures are especially likely to get meningitis.[7] The efficacy of prophylactic antibiotics in these cases is uncertain.[8]

Temporal bone fractures

Acute injury to the internal

carotid dissection, occlusion, pseudoaneurysm formation) may be asymptomatic or result in life-threatening bleeding. They are almost exclusively observed when the carotid canal is fractured, although only a minority of carotid canal fractures result in vascular injury. Involvement of the petrous segment of the carotid canal is associated with a relatively high incidence of carotid injury.[9]

Motor racing accidents

Basilar skull fractures are a common cause of death in many

Greg Moore, and Gonzalo Rodriguez; and ARCA drivers Blaise Alexander and Slick Johnson. Ernie Irvan is a survivor of a basilar skull fracture sustained at an accident during practice at the Michigan International Speedway in 1994.[10] Race car drivers Stanley Smith and Rick Carelli also survived a basilar skull fracture.[11][12]

To prevent basilar skull fractures, many motorsports sanctioning bodies mandate the use of head and neck restraints, such as the HANS device.[13][14][15][16] The HANS device has demonstrated its life-saving abilities multiple times, including Jeff Gordon at the 2006 Pocono 500, Michael McDowell at the Texas Motor Speedway in 2008,[17] Robert Kubica at the 2007 Canadian Grand Prix, and Elliott Sadler at the 2003 EA Sports 500/2010 Sunoco Red Cross Pennsylvania 500.[18]

References

  1. ^
    PMID 25086806
    .
  2. ^
    PMID 24122671
    .
  3. ^
    PMID 25918919
    .
  4. ^ a b c Pediatric Head Trauma at eMedicine
  5. ^ Skull Fracture at eMedicine
  6. ^ "About Brain Injury". Brain Injury Association of America. October 12, 2012. Archived from the original on December 13, 2017. Retrieved July 5, 2015.
  7. PMID 6680635
    .
  8. ^ Butler, John. "Antibiotics in base of skull fractures". BestBets. Retrieved 2014-03-22.
  9. PMID 9179890
    .
  10. ^ https://www.youtube.com/watch?v=ckT7z-XwKUo Dale Jr. Download: Ernie Irvan's Horrific Crash
  11. ^ Zenor, John (June 9, 2001). "Former Winston Cup driver Smith leaves horrid accident in past". Arizona Daily Sun. Archived from the original on December 10, 2020. Retrieved December 10, 2020.
  12. ^ Wack, Craig (June 21, 2009). "Rick Carelli's seat safer than '99 Trucks Series ride". The Commercial Appeal. Retrieved 3 February 2010.
  13. ^ "FIA makes HANS device mandatory". Autosport. Autosport Media UK. 9 December 2005. Retrieved 2 January 2018.
  14. ^ "NASCAR mandates HANS for 3 series". The Washington Times. The Washington Times LLC. 18 October 2001. Retrieved 2 January 2018.
  15. Motor Sports Association. Archived from the original
    on 2 January 2018. Retrieved 2 January 2018.
  16. ^ "Head and Neck Restraints Mandatory!". NNJR SCCA. Sports Car Club of America. Archived from the original on 3 January 2018. Retrieved 2 January 2018.
  17. ^ ANDERSON, LARS. "HOW SAFE IS RACING?". SI.com. Retrieved 2018-04-04.
  18. ^ "Sadler: Sunday's crash hardest in Cup history". ESPN.com. 2010-08-03. Retrieved 2018-04-04.

External links

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