Outcome of management of elevated skull fractures in Enugu, South-East Nigeria

Abstract

Introduction: Elevated skull fractures, previously thought of as a very rare variety of fractures, are no longer very uncommon. They are expectedly gradually finding a slowly growing list of references in neurosurgical literature. They are mostly posttraumatic compound fractures due to the mechanism of injury. Outcome of operative neurosurgical care is generally rewarding.

Materials and Methods: A 4‑year retrospective study of case notes, operation registers, and radiology records of patients diagnosed with elevated skull fractures who had neurosurgical care at the University of Nigeria Teaching Hospital, Enugu, Nigeria, between 2012 and 2015, was done. Only patients with evidence of elevated skull fracture on head computed tomography scan were included. The presenting Glasgow Coma Score and Extended Glasgow Outcome Score (GOSE) at the time of discharge from the hospital and 6 months thereafter were analyzed.

Results: Out of 209 patients managed with skull fractures over the study period, eight met the inclusion criteria. Seven (87.5%) were males. The latency to presentation was 6 h in one case and >8 h in the other cases. All the patients had operative care involving debridement, duroplasty, and bone‑fragment realignment (cranioplasty) either primarily or on an interval basis. The GOSE at 6 months was at least 7 in 87.5% of the patients.

Conclusions: Despite the grotesque appearance at presentation, outcome of properly managed elevated skull fractures is good.

Keywords: Cranioplasty, duroplasty, elevated skull fracture, extended Glasgow
Outcome Score