Helmets for preventing injury in motorcycle riders. Impact of helmets on injuries to riders of all-terrain vehicles. Bowman SM, Aitken ME, Helmkamp JC, et al. Injury prevention and recreational all-terrain vehicle use: the impact of helmet use in West Virginia. Pediatric bicycle injury prevention and the effect of helmet use: the West Virginia experience. Helmet use and reduction in skull fractures in skiers and snowboarders admitted to the hospital. Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders. Does padded headgear prevent head injury in rugby union football? Med Sci Sports Exerc. A 5-year study of the outcome of surgically treated depressed skull fractures.
CT evidence of intracranial contusion and haematoma in relation to the presence, site and type of skull fracture. Skull fractures in infants and predictors of associated intracranial injury. Traumatic brain injury during Operation Iraqi Freedom: findings from the United States Navy-Marine Corps Combat Trauma Registry. Galarneau MR, Woodruff SI, Dye JL, et al. Minor head injury: guidelines for the use of CT - a multicenter validation study. Predictable patterns of intracranial and cervical spine injury in craniomaxillofacial trauma: analysis of 4786 patients. Mithani SK, St-Hilaire H, Brooke BS, et al. Pediatric depressed skull fractures: analysis of 530 cases. Traumatic injuries: imaging of head injuries.
BASILAR FRACTURE SYMPTOMS SERIES
Skull fracture as a risk factor of intracranial complications in minor head injuries: a prospective CT study in a series of 98 adult patients. There was no statistically significant difference in all-cause 28-day mortality, Disability Rating Scale score at 6 months, or progression of intracranial hemorrhage.ġ. A favorable functional neurologic outcome (measured as Glasgow Outcome Scale-Extended >4 at 6 months) occurred in 65% of patients in the tranexamic acid groups versus 62% with placebo.
BASILAR FRACTURE SYMPTOMS TRIAL
However, its results should be interpreted with some caution due to: significance only in the subgroup analysis change in recruitment (from within 8 to within 3 hours of injury) change in primary outcome (from all-cause to disease-specific mortality) and the risk of selection and observer bias. One randomized controlled trial published in 2020 (N=1280, 20 centers and 39 emergency medical services agencies in the US and Canada) compared tranexamic acid with placebo within 2 hours of moderate or severe traumatic brain injury. One large randomized control trial (12,737 patients) showed a reduction in mortality in patients with mild-to-moderate head injury (baseline Glasgow Coma Scale 9-15) who were treated with tranexamic acid (an antifibrinolytic agent) within 3 hours of injury, compared with those who were not. There are no data to support the use of the "halo" sign, where CSF may be distinguished from blood/mucus by the formation of a "halo" when fluid is deposited on filter paper, as a specific or sensitive marker for CSF leakage. Furthermore, these signs may assist in localization of the basilar fracture Battle sign and otorrhea are most often associated with fractures of the petrous portion of the temporal bone, while periorbital ecchymosis and CSF rhinorrhea are more often associated with fractures of the anterior cranial fossa. The positive predictive value in detecting a basilar skull fracture is 85% for a unilateral raccoon eye, 66% for the Battle sign, and 46% for bloody otorrhea. Cerebrospinal fluid (CSF) leakage can result in CSF rhinorrhea or otorrhea. Blood pooling from these fractures can result in ecchymosis over the mastoid area (e.g., Battle sign) periorbital ecchymosis (raccoon eyes), particularly if unilateral and bloody otorrhea. Small-caliber high-velocity weapons result in punched-out lesions, while large missiles often result in wedge-shaped fractures with cantilevering of the fragments.īasilar skull fractures often have specific clinical features. In such cases, the type of fracture is dependent on the proximity of the weapon and type of ammunition used. Occasionally, skull fractures can be secondary to penetrating trauma such as gunshot wounds. However, it must be kept in mind that these signs are specific but not sensitive. The one exception is basilar skull fractures, which may be associated with highly specific clinical signs such as blood pooling resulting in ecchymosis over the mastoid (Battle sign) or periorbital areas (raccoon eyes), hemotympanum, cerebrospinal fluid leakage resulting in clear rhinorrhea or otorrhea, or cranial nerve injury resulting in facial paralysis or hearing loss. Clinical signs may be absent or nonspecific, such as scalp lacerations or swellings or tenderness on palpation.
Skull fractures are usually the result of blunt force trauma such as falls, traffic accidents, or assaults.
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