Fate of Cranial Defects Secondary to Fracture and Surgery

STUDIES of the persistence of fracture lines have been much neglected in medical literature, though the scientific and medico-legal value is of considerable importance (Stewart, 1925; Glaser and Blaine, 1936). From a clinical viewpoint it is extremely valuable to be able to prognosticate the persistence of cranial defects, either traumatic or operative, and further, to be able to inform the patient of the length of time necessary for a bone graft to fill such defect. An intensive and prolonged study shows that the healing of linear fractures depends, to a great degree, upon the age of the patient. The disappearance of the fracture line occurs much earlier in children than in adults. The width of the fracture also plays a part in the prolongation of its visibility upon the roentgenogram. Occasionally, if the fractures are too wide, absorption rather than healing of the fracture takes place. Ossification around the fracture and of the fracture itself may also occur. The location of a fracture in the skull also is an essential factor to be considered. In certain instances, fractures in the occipital area take much longer to disappear than in other parts of the cranium. It is well known that delayed union, and sometimes non-union, of fractures of the long bones occur: whether a similar bio-chemical process takes place in skull fractures is a matter yet to be ascertained. In this series of 150 patients, x-ray films have been taken at varying intervals following fractures to determine the ability of the skull to repair such defects. In all instances, attention was directed to a duplication of the x-ray technic carried out in the original roentgenograms. The entire group has been classified as follows: 1. Linear Fractures: 1. Disappearance of fracture line in children under six years of age. 2. Disappearance of fracture line in adults. 3. Widening of fracture line in children and adults. 2. Depressed Fractures: 1. Without elevation of fragments. 2. Hammering out of fragments. 3. Cranial defects. 4. Replacement of fragments at time of operation. 5. Osteoperiosteal grafts. 3. Osteoplastic Bone Flap: 1. Normal bone flap. 2. Degeneration of the bone flap. Linear Fractures 1. Children.—There are eight children under six years of age in this group. Fading of the fracture became apparent within two months after injury, and within six months after injury the fracture line disappeared in every instance, excepting one. Case 1, S. F., male child, aged six years. This child was struck by an automobile, the wheels running over his head, giving him a tremendous fracture of the skull with many branches of the fracture line. There was considerable separation of one of the more extensive fractures, passing practically the whole length of the vault.