RESUMO
The aim of the study is to examine the efficacy of a conservative approach in the management of depressed skull fractures. A prospective study of 120 patients with depressed skull fractures treated at Salmaniya Medical Complex from January 1998 to December 2006. There were 108 males and 12 females, age range was 12 months to 80 years, and the mean age was 40 years. All patients underwent skull x-ray and cranial CT scan. Depressed fractures due to missile injuries were excluded from the study. Selective criteria for conservative and surgical managements were specified. The group treated conservatively compared favourably with surgical group in outcome. Object fall on the head was the cause of depressed fracture in 30% of our patients, fall from a height in 19%, road traffic accident in 20%, sports injury in 10%, assault in 19.8% and suicidal attempt in 1.2%. Parietal bone was injured in 44%, frontal bone in 32%, temporal bone in 18% and occipital bone in 6%. Seventy-two percent were compound depressed fractures and 28% were simple depressed fractures. Eighty-four patients were managed conservatively, 56 patients with compound fractures [66.7%] and 28 patients [33.3%] with simple fractures. Significant extra-axial haematoma was the indication for elevation of the fracture in 40% of the surgical group, significant wound contamination, brain tissue and CSF in the wound in 5%, frontal sinus involvement in 15%, cosmetic deformity in 25%, fracture on the superior sagittal sinus in 10% and right sided hemiplegia in 5%. Our study demonstrates that 70% of patients with depressed skull fractures can be safely managed conservatively without major surgical intervention. The major proportion of compound depressed skull fractures [66.7%] can be selected for conservative treatment without compromise of health and with a major socioeconomic advantage and short hospital stay