A depressed skull fracture is one of several different types of fractures that may occur in the skull or head. It usually only occurs under special types of circumstance when the head sustains a direct blow that is also very forceful. When this happens, as the bone breaks, it may push in toward the brain, which can be a very dangerous circumstance. In some cases, bone matter may even cause injury to the brain.
The types of circumstances under which a depressed skull fracture may happen are quite specific. The head must be hit with great force, and usually with a hard object. This is often the subject of “whodunit” mystery novels, where a victim is injured or dies after being hit on the head with things like wrenches, large rocks or baseball bats. Yet these fractures are not simply fictional, and there are many instances where people sustain them in real life.
There is further clarification between an open or closed depressed skull fracture. In an open injury, the skin is broken, usually down to the bone. The closed type means the skin is intact. Open injuries could mean additional repair of skin and blood vessels to stem surface bleeding, but closed types may result in bleeding in the brain and brain injury too. Both are dangerous.
Typically if a person has a suspected depressed skull fracture, this is a medical emergency, regardless of whether the person is conscious and talking or unconscious. Doctors need to determine type of fracture right away, usually via x-ray or other scans, so they can address how to treat it. With the depressed form, treatment types could depend on severity of injury. Usually, a quarter inch (.64 cm) or more of depression indicates that surgery must be performed.
Another way of looking at this is to say surgery is likely if bone depression is approximately equal to bone width. When only a small depression is made that is less wide than the bone itself, doctors may not do any form of surgery. On the other hand, the larger the depression is, the more likely surgery could be needed. Greater injury suggests potential for small bone pieces to touch the brain too, and this could have long-lasting effects on brain function, if not repaired.
The other consideration in evaluating a depressed skull fracture is determination of bleeding in the brain or in the spaces around it. When severe concussion has occurred, other surgery might be needed to stop bleeding or drain blood that can constrict around the brain. Such surgery would probably be part of any bone repair surgery, or it might be done alone if repair of the fracture is not necessary.
Protecting the head from fractures and concussions is a valuable enterprise. Though many activities are unlikely to result in a skull fracture, it’s still advised people wear appropriate safety gear, especially helmets, for many physical activities. Additionally, wearing things like seatbelts is advised to cut down on potential head injuries occurring in things like car accidents.