Skull Fracture

  • Etiology: trauma
  • Imaging:
    Linear – simple fracture with the skull fragments closely approximated
    Diastatic – complex fracture with the skull fragments spread apart
    Depressed – complex fracture with the skull fragments entering into the cranium
    Ping Pong – etiology is depression of plastic fetal skull against maternal sacral promontory or forceps, usually no intracranial injury, clinically spontaneously resolve
    Growing (leptomeningeal cyst) – etiology is following diastatic fracture, dura is interrupted and there is erosion of fracture edges due to CSF pulsation, clinically is unique to infants less than 3 years old,
    Healing – skull fracture, which involve membranous bone, heals without periosteal reaction and slowly disappears

Cases of Skull Fracture

Radiograph of a linear skull fracture
Lateral radiograph of the skull shows bilateral linear parietal lucencies coursing across the skull.
CT of a diastatic skull fracture
3D reconstruction from a CT without contrast of the brain shows a wide right parietal lucency between two separated fragments of bone.
CT of a depressed skull fracture
Axial CT without contrast of the brain shows depression of the skull in the left temperoparietal region with an associated subgaleal hematoma containing subcutaneous air.
Radiography of a growing skull fracture (leptomeningeal cyst)
3D CT reconstruction initially (left) showed a diastatic skull fracture which has increased in size on the lateral radiograph of the skull (right) taken 2 months later.
CT of an (not) accessory skull suture
3D reconstruction from CT without contrast of the brain (left) shows a linear straight lucency that connects to the left lambdoid suture. Coronal CT (right) shows the same linear lucency lying under a large subgaleal hematoma.
Radiographs of a healing skull fracture
Lateral radiograph of the skull initially (left) showed bilateral linear parietal lucencies coursing across the skull which are no longer seen 4 months later (right).