Introduction: To describe the clinical presentation, neuro-radiology findings, medical and surgical management, and complications of patients with compound elevated skull fractures at a busy Neurosurgical Department in Durban, South Africa.

Methods: Retrospectively evaluated the medical records of patients admitted from January 2005 to December 2016 with compound elevated skull fractures. Data was analyzed for demographics, clinical presentation, mechanisms of injury, neuro-radiology findings, management and outcomes.

Results: Twelve patients were included in series with a mean age of 30 years, average admission Glasgow Coma Scale of 12 and focal neurological deficit in eight patients on admission. Intra-cerebral haematoma was the most common associated intracranial haematoma [n=9, 75%]. Neuro-radiological images were assessed and elevated bone segment classified into three distinct types: Type 1 – fractured segment with minimal loss of contact with rest of cranial vault, Type 2 – fractured segment with partial loss of contact with rest of cranial vault, Type 3 – fractured segment with complete loss of contact with rest of cranial vault. All patients underwent surgery to debride and repair dura [n=11, 91%] when injured. Replacement of elevated bone was done in 50% of cases. With regards to outcomes, one patient demised whilst the remaining 11 patients had favourable outcomes at discharge (Glasgow Outcome Scale 4 or 5).

Conclusions: Compound elevated skull fracture is an additional subtype of skull vault fracture. Prompt neurosurgical management with appropriate operative management of dura and elevated bone fragment may reduce morbidity from septic complications and mortality from underlying brain injury.

Patient Care: By understanding the surgical management options for compound elevated skull fractures, one would be able to select the most appropriate option in an individual patient.

Learning Objectives: 1. Include compound elevate skull fracture as part of the classification of skull fractures. 2. Describe the mechanisms of injury of compound elevated skull fractures. 3. Understand the surgical management options for compound elevated skull fractures.

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