Correlation of fracture depression level and dural tear in patients with depressed skull fracture

Abstract

INTRODUCTION: Trauma is the leading cause of morbidity and mortality worldwide, 80% of which is due to head trauma. Simple depressed cranial fractures are being treated conservatively; however, dural tear is an indication of surgical intervention. Computed tomography (CT) scan is the method of choice for initial evaluation of patients with head trauma. This study was designed to evaluate the correlation of dural tear and level of depression in cranial fractures, considering surgical findings as gold standard. MATERIALS AND METHODS: A total of 40 patients with depressed skull fracture were admitted to the trauma center of Tabriz University of Medical Sciences, who were candidates for surgery and underwent cranial CT scan; the level of fracture depression was calculated. Surgical findings and status of dural integrity was recorded for each patient. Finally, surgical findings and mean level of depression in both groups were compared. RESULTS: The mean age of cases was 26.4آ±16.9 years. There was no statistically significant difference between the groups considering the cause of fracture. The most prevalent symptom on admission was headache. Mean Glascow Coma Scale score was significantly lower in the group with torn dura. Mean levels of depression, based on CT findings, were 14.7آ±4.6 mm in patients with intact dura and 23.5آ±8.9 mm in patients with dural tear, which was considerably higher in the patients with torn dura. CONCLUSIONS: There was remarkable correlation between the level of fracture depression and dural tear; fracture depression level was considerably higher in patients with dural tear than in cases with intact dura. The cutoff point was 14 mm with 77% sensitivity. Copyright é 2013 by Lippincott Williams & Wilkins.