Primary Repair of Compound Skull Fractures by Replacement of Bone Fragments

N EUROSURGEONS are almost unanimous in their agreement with the principle of early debridement of compound skull fractures. However, there are many differences of opinion as to the immediate handling of the bony defect which follows debridement. The classical and aecepted method involves total resection of all the contaminated bone and fragments at the fracture site. r,s,l~ A second operation for cranioplasty is then performed at a later date. We believe that primary repair of these bony defects can be achieved by the replacement of bone fragments at the time of the initial debridement. This can be accomplished without danger to the patient. Gross contamination, even in the presence of dural or brain laceration, does not contraindicate bone replacement provided the dura can be sutured. During a 17-year period at the University of Michigan Medical Center, 79 patients were treated with replacement of free bone fragments as a primary procedure in compound skull fractures. Only two patients became infected, and in only one of them did the bone fragments have to be removed. An excellent cosmetic and functional result with solid skulls was achieved in 75 out of 79 patients. No patient developed osteomyelitis. This report extends that of Carrington, et al./from this clinic in which 20 eases were reported in 1960. This technique is not without precedent, since MacEwen 6 in 1888 replaced bone fragments after washing them in bichloride of mercury. Coleman, a Lyerly, 5 and Browder 1 also support the idea of early return of bone fragments provided there is no gross contamination of bone and if the dura has not