Role of computed tomography scan in assessment of skull fracture patterns among motorcycle road traffic accident patients in South Western Nigeria

Background: Commercial motorcycling is a common means of transportation in Nigeria, and motorcycle road traffic accidents (MCRTAs) are commonly associated with multiple skull fractures. Cranial computed tomography (CT) scan is the standard imaging modality of patients with head injury. Aim: The aim of this study is to describe the pattern of skull fractures on cranial CT scan in patients with head injury following MCRTA. Patients and Methods: This was a descriptive cross-sectional study conducted at the University College Hospital, Ibadan, between June and October 2016. Noncontrast cranial CT scan was performed on 190 patients who presented with head injury following MCRTAs. Results: Over half (n = 59.8%) of the patients were within the ages of 20­39 years with a mean age of 33 ± 14.37 years. A total of 183 patients did not use crash helmet at the time of accident, out of which 168 (n = 88.4%) sustained skull fractures. Six different skull fracture patterns were identified on cranial CT scan of these patients. The most common fracture pattern seen was the combined calvarial, facial, and base of skull fractures representing 22.1% while the least fracture pattern was the base of skull fracture (n = 4.7%). Most of the patients with calvarial fractures were without helmet at the time of injury (n = 98.3%) compared to 1.7% of patients who wore helmet at the time of injury. This was statistically significant (P = 0.040). Conclusion: This study further underscores the usefulness of cranial CT scan in identifying and evaluating patients with skull fractures following MCRTA in our environment, thus guiding proper medical and surgical management of such patients in a low-resource setting

Prevalence and pattern of basal skull fracture in head injury patients in an academic hospital

Background: Basal skull fractures (BSFs) have been reported to be a major cause of morbidity and mortality in the literature, particularly in young male patients. However, there are limited data available on the aetiology, prevalence and patterns of such observed in South Africa. Objectives: To evaluate the prevalence and pattern of BSF in head injury patients referred to Dr George Mukhari Academic Hospital, Gauteng, South Africa. Methods: Patients of all ages with head injuries were considered for the study, and those who met the inclusion criteria were scanned using a 128-slice multidetector helical computed tomography (CT) machine after obtaining consent. Data were prospectively obtained over a 6-month period, interpreted on an advanced workstation by two readers and statistically analysed. Results: The prevalence of BSF in this study was found to be 15.2%. The majority of patients (80.5%) were under 40 years old, with a male to female ratio of 3:1. The most common aetiology of BSF was assault, which accounted for 46% of cases. The middle cranial fossa was the most frequently fractured compartment, while the petrous bone was the most commonly fractured bone. There was a statistically significant association between head injury severity and BSF, and between the number of fracture lines and associated signs of BSF (p < 0.001). The sensitivity of clinical signs in predicting BSF was 31%, while specificity was 89.3% (p = 0.004). Conclusion: The prevalence and pattern of BSF found were consistent with data from previously published studies, although, dissimilarly, assault was found to be the most common aetiology in this study

Evaluation of locally manufactured patient-specific custom made implants for cranial defects using a silicone mould

Background: Cranial vault defects can pose a significant problem for neurosurgeons where autologous bone is no longer available for cranioplasty. Numerous materials exist to create implants which include polymethyl methacrylate (PMMA) and titanium. A technique using 3-dimensional CT scan reconstruction of a cranial defect and creating a silicon mould which can be autoclaved in theatre to create a PMMA implant was developed. Objectives: The aim of this study is to evaluate the efficacy, cosmetic result, safety and cost-effectiveness of this procedure and compare this to existing techniques.Methods: An ambispective study was performed in patients requiring cranioplasty with a custom made implant. Patients were assessed for risk factors and cosmetic outcome, surgical technique was described and complications and cost compared to existing literature between 2010 and 2016.Results: Thirty retrospective and 30 consecutive prospective patients were recruited into the study. Overall sepsis rate was 8.3%. All septic cases had superficial sepsis of which 2 grafts were removed due to cerebrospinal fluid leakage resulting in wound breakdown. A 100% accurate implant to defect ratio was achieved leading to a high satisfaction rate. Average cost was 5 times cheaper than the closest market related product.Conclusion: Patient specific moulds using PMMA to create custom implants are safe, have excellent cosmetic results and are a very cost-effective option to manage cranial defects. Accurate planning strategies for large craniotomies, where bone will potentially be discarded, add to surgical effectiveness and cost-saving to the patient

Etude epidemiologique; clinique et therapeutique des fractures embarrures du crane a propos de 72 cas dans le service de neurochirurgie du CHU Gabriel Toure

Introduction : Les fractures embarrures constituent des affections frequentes en neurochirurgie dont la gravite est liee aux lesions intracraniennes associees. Les objectifs de ce travail sont les suivants : decrire les caracteristiques epidemiologiques des fractures embarrures du crane; determiner les etiologies; decrire les signes cliniques; degager les complications et les sequelles et evaluer la prise en charge. Patients et Methodes : il s'agissait d'une etude retrospective descriptive portant sur 72 malades de janvier a decembre 2013 dans le service de neurochirurgie du CHU Gabriel Toure. La frequence etait de 14;7% avec une forte predominance masculine (93% des cas). Les jeunes de 16-25 ans etaient les plus touches soit 38;9%. Les AVP constituaient la principale etiologie avec 59;7% des cas. Le traitement neurochirurgical a ete effectue chez 25 patients soit 34;72% et la craniectomie a os perdu etait la technique la plus utilises (64% des cas operes). L'infection de la plaie a ete la complication post operatoire dominante avec 15;3%. le taux de mortalite etait de 1;39%

Fracture Patterns in Non-Accidentally Injured Children at the Red Cross Children's Hospital

Background: Unexplained fractures in infants and children often suggest abuse. The fracture patterns with high specificity for abuse are well documented; however; in practice these patterns occur infrequently and abused children may present with a wide spectrum of bony injuries. The Child Accident Prevention Foundation of South Africa (CAPFSA) keeps a database of children treated at the Red Cross War Memorial Children's Hospital (RXH) in Cape Town. Methods: The medical records of all children admitted between January 1991 and October 2005 were reviewed and children with fractures resulting from non-accidental injury (NAI) were included in the study. Results: During the 14-year study period; 99586 trauma patients were treated at RXH; of which 1037 (1.04) were diagnosed with non-accidental injury. The majority was male (64). An the average age was 44.8 months. Of the 1037 patients diagnosed with NAI; 121 (11.7) sustained a total of 149 fractures; 21 (17.3) with multiple fractures (16 had 2 fractures; 3 had 3 fractures and 2 had 4 fractures). The head and neck was the most frequently fractured anatomical area (53); followed by the upper limb (24) and lower limb (18). Only 7 fractures of the trunk were seen. Children sustaining fractures of the head and neck were significantly younger than those sustaining fractures to other areas. Discussion: Although the established consensus on fracture patterns in NAI is that long bone fractures are the most frequently experienced in clinical practice; the principal finding of our study was that skull fractures were considerably more common; nearly 40of all fractures were skull fractures. Skull fractures were associated with violent injury; approximately one-third were reported to have been inflicted with an implement/weapon and one-quarter of these children had multiple fractures at the time of presentation. This underlines the importance of local studies; as socio-cultural issues underpin many of the aetiological factors related to disease burden in general; and to child abuse in particular

Les fractures du rocher au CHU de Yopougon-Abidjan

Les fractures du rocher constituent un grand groupe d'affections causees par les traumatismes craniens. Elles ont une facheuse reputation aupres du public. Elles touchent essentiellement les jeunes. Le diagnostic est radiologique (scanner). Le signe le plus rencontre est l'otorragie. La conception therapeutique actuelle de son traitement reclame une vision globale; de l'accident a la reinsertion sociale. Dans les pays developpes le pronostic est relativement bon. Dans nos contres; nous sollicitons participer a l'elaboration des donnees de cette facheuse affection en degageant le profil general des fractures du Rocher au CHU de Yopougon. Nos objectifs specifiques sont : - Preciser les caracteristiques epidemiologiques de l'affection; -Determiner les principaux aspects cliniques; -Recenser les differents types de fractures retrouves radiologiquement; -Determiner les principales therapeutiques adaptees a nos contrees. METHODOLOGIE : A travers une etude retrospective et descriptive sur une duree de 7 ans de janvier 1996 au mois de decembre 2002 au CHU de Yopougon; dans les services d'ORL et de neurochirurgie essentiellement. Nous avons recrute tous les malades qui avaient un cliche scannographique avec une solution de continuite du rocher. NOS RESULTATS sont les suivants : Sur le plan epidemiologique; la fracture du rocher est une affection frequente. Elle represente 8;05 pour cent de cas des traumatismes craniens avec une moyenne de 8 malades par an. L'age de la population est en moyenne de 24;43 ans. De plus 87;27 pour cent des patients qui ont moins de 40 ans. L 'etiologie est dans tous les cas un traumatisme cranien avec pour principale cause les accidents de la circulation qui representent 67;27 pour cent des cas de notre serie. La clinique est faite essentiellement de trouble de conscience a l'arrivee du malade aux urgences chirurgicales. Apres cette phase neurochirurgicale; la phase fonctionnelle est marquee par: L'otorragie; qui est le principal signe voire souvent le seul. L'otorragie est parfois associee a la rhinorragie et ou a l'otoliquorrhee. Enfin la phase sequellaire est faite de troubles de la marche; de l'equilibre et nerveux. Du point de vue radiologique; il s'agit dans 71;66 pour cent des cas d' une fracture longitudinale ou extra labyrintique. Les atteintes mixtes et transversales se partagent presque equitablement le reste de cas . La fracture est bilaterale dans 9;09 pour cent des cas. Nous n'avons pas retrouve une predominance d'atteinte selon le cote. Pour ce qui concerne la therapeutique et l'evolution; il s'agit d'une prise en charge uni disciplinaire par le service de neurochirurgie (83;64pour cent). Le moyen therapeutique est en majorite medical. Il est associe a la chirurgie dans 9;09 pour cent des cas. Le suivi des patients n'est pas satisfaisant. Parmi nos patients 65;45 pour cent des cas sont perdu de vue. L'evolution est defavorable dans 34;55 pour cent des cas. Les sequelles sont des troubles nerveux a type d'aphasie; de cephalees chroniques et d'hypoacousie. Notre travail nous emmene a suggerer les propositions suivantes: 1) Du point de vue de la sante publique et a l'endroit des administrateurs : -Un reel developpement des actions de sensibilisation pour ameliorer la conduite routiere par l'Office de Securite Routiere (O.S.E.R.); -Une multiplication des services d'evacuation medicalises afin de faire face a l'urgence et a la delicatesse des cas de nos patients. 2) Du point de vue therapeutique et de ltmyiication du personnel medical : -L'encouragement d'autres travaux de type prospectif sur ce sujet est indispensable pour comparer les donnees ci-dessus; -La collaboration interdisciplinaire entre I'ORL et la Neurochirurgie plus renforcee; -La formation des specialistes en oto neurochirurgie; -La meilleure sensibilisation des malades sur la necessite du suivi et sur les complications graves dus a cette affection