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The skull is the bony skeleton of the head that consists of the cranium which surrounds the brain and the facial skeleton. It has a number of functions including housing of and protection of the brain, housing of the special senses organs, providing attachment points for muscles in the head and neck and aiding with the forming of the first parts of the digestive and respiratory tracts. When there is a break in one or more of the skull bones due to an injury then it is said the skull is fractured. In most cases of skull fracture the bone is cracked without any displacement of the broken pieces. This is what is known as a closed fracture or simple fracture. In more severe cases the bone fragments are displaced resulting in an open or depressed skull fracture. Since the bones in the skull are extremely strong this usually only occurs in cases are severe head injury where the blood vessels in the membrane that covers the brain are ruptured causing bleeding into the space between the skull and the outer membrane.
When a skull fracture is caused by a break in the skull bone the injured arteries and veins bleed into the spaces around the brain tissue. If the fracture is at the base of the skull and tears the meninges, the fluid that circulates between the brain and meninges has been known to leak through the ears or nose. When this occurs bacteria can enter the skull through the fracture causing an infection that can lead to severe brain damage. Although most skull fractures do not require surgery, except in cases where the bone fragments are pressing against the brain or the bones have been jolted out of alignment, all skull fractures are considered serious since the amount of damage to the brain may not always correlate with the damage to the skull.
Symptoms of skull fractures may include headaches, confusion, persistent blurred vision, unconsciousness, amnesia or loss of memory, muscles weakness, paralysis, loss of sensation, vomiting, unequally sized pupils, double vision and even deteriorating levels of consciousness that suggest progressive brain damage. In severe cases in the area of the base of the skull there may be a discharge from the nose or ears. Even if none of these symptoms are present a person who has received a significant blow to the head should consult a physician. When hemorrhaging is suspected a CT scan will be performed. If the person is diagnosed with a closed fracture they will be hospitalized and observed for complications. When no symptoms are present after 24 hours treatment may not be needed since the fracture may heal itself.
In most cases an open fracture will be treated by a neurosurgeon since any sign of hemorrhaging can necessitate that the blood be drained followed by repairs to the damaged arteries or blood vessels. If the fracture is deeply depressed and has damaged the meninges or brain tissue surgery must be performed to remove the pieces of fractured bone and repair the damaged tissue. With all open fractures antibiotics will be given due to the risk of infections that can lead to meningitis or encephalitis. In severe cases permanent physical or mental disabilities may be present. Recovery in severe cases of skull fracture is usually slow with the person showing progressive signs of recovery for up to five years.
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