Causes of delay in the definitive treatment of compound depressed skull fractures: A five-year study from Nigeria

Abstract

Background: Calvarial fractures may be linear, depressed or ping-pong, and each can be compound (open) or simple (closed). When depressed fractures become compound, they cause contamination, resulting in intracranial sepsis. All depressed fractures with scalp breach are considered compound, whether or not the breach is contiguous with the fracture. They, therefore, become almost an absolute indication for operative treatment by elevation and debridement, to avert intracranial sepsis. Definitive treatment should be within 72 hours or else it would be unsafe to preserve the bone fragments.
Method: This was a retrospective study in which a review of the outcome from management of compound depressed skull fractures (CDSF) in the Institute of Neurological Sciences, University College Hospital, UCH, Ibadan Nigeria referral Centre for neurological diseases was undertaken from November 1997 to October 2002. Data was retrieved from ward, theatre and out-patient records and subsequently analyzed for the time interval between time of injury treatment and the cause of delays in surgery, if any.
Results: Of the 75 cases treated for CDSF with a Male: Female ratio of 11.5:1, only 54 had complete records and all were treated by elevation, debridement and craniectomy, resulting in cranial defects. There was delayed treatment in most of the cases at various stages from the time of injury, with most of them arising after presentation in our Centre.
Conclusion: Delayed treatment, was our major source of morbidity and most of the delay was traceable to our hospital processes. Scalp suturing before definitive treatment did not contribute to delay. Non-specialist care givers should be encouraged to refer patients without delay.