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  • Is Surgery Really Beneficial in Compound Skull Fractures? A Multivariate Analysis

    Final Number:

    SS Dhandapani M.Ch.; AC Sarda; KK Mukherjee; M Tripathi; SN Mathuriya

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Compound skull fractures have conventionally been treated surgically especially when there is evidence of dural penetration. However the evidence for this is limited. This study was to comparatively assess surgical debridement and bedside wash & suturing in patients with compound skull fractures.

    Methods: Patients of compound skull fractures with no significant intracranial hematoma were studied for various factors in relation to surgical or conservative management, survival without major infection, unfavorable neurological outcome and late posttraumatic seizures.

    Results: Out of 671 patients with compound skull fractures, 258 patients had complete clinico-radiological details with no significant intracranial hematoma. Of these 201 and 57 were managed conservatively and surgically respectively. There was no significant baseline difference with respect to age, GCS, admission interval and internal compounding between the surgical and conservative groups. The motor vehicular accidents, brain matter leak and CSF leak were significantly greater in surgical group(p=0.001,<0.001 & 0.04 respectively). In univariate analysis, survival with no major infection, unfavorable outcome and late posttraumatic seizures had no significant difference among the surgical and conservative groups. (p=0.33,0.1 & 0.36 respectively). In multivariate analysis adjusting for age, mechanism of trauma, admission GCS, internal compounding, pneumocephalus, brain matter & CSF leak, and surgical intervention, only GCS emerged as the independent risk factor associated with both survival with no major infection and unfavorable neurological outcome (p<0.001). Surgical intervention had no significant benefit overall either on survival with no major infection, unfavorable neurological outcome or late posttraumatic seizures. In subgroup analysis, the only factor which tilted the benefit towards surgical intervention was brain matter leak (p=0.01).

    Conclusions: Surgical debridement appears to have no significant benefit over simple suturing in patients with compound skull fractures except possibly in the subgroup with brain matter leak.

    Patient Care: Surgical debridement may not really benefit patients with compound skull fractures except when there is brain matter herniation

    Learning Objectives: By the conclusion of this session, participants should be able to: 1)Describe the prognostic factors in patients with compound skull fractures, 2)Discuss the evidence on managing these, 3)Comparatively evaluate surgical and conservative management in these patients


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