Association between skull fracture type and extradural hematoma characteristics: Volume, source of bleeding, and intraoperative clot features

Objective: To evaluate the association between skull fracture type underlying the extradural hematoma (EDH) and the clot characteristics, including hematoma volume, source of bleeding, and clot morphological features. Methodology: This retrospective observational cohort study was conducted at Department of Neurosurgery, Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan, from November 2025 to April 2026 and included all patients with EDH. We analyzed data using SPSS version 27.0. Fisher's exact test and the Kruskal-Wallis were used test to evaluate the association between fracture type and various EDH features. Results: Of the total 100 patients included in the study, 75.55% (75) were male, and the mean age was 30.60±13.01 years. Motor vehicle accident was the most common (75.00%, 75) cause of EDH. The mean presenting GCS was 12.35±2.16. Linear fractures were most common (55.00%, 55), followed by depressed fractures (32.00%, 32). Linear fractures had higher mean age ranks (p=0.044). Dural rent was significantly more frequent in depressed fractures (p=0.003), whereas linear fractures demonstrated intact dura. Midline shift was also observed in linear fractures and was statistically significant (p=0.001). However, fracture type in EDH was not associated with admission GCS, hematoma volume, source of bleed, clot color, or clot consistency. Conclusion: Linear fractures were most common with increasing age and had higher rates of midline shift than depressed fractures. Dural rents were more commonly seen in depressed fractures. However, clot characteristics were not associated with the fracture type underlying the EDH.