Clinical Analysis or Primary Reconstruction to Compound Depressed Frontal Skull Fracture

ABSTRACT

The injured skull bone may be contaminated in compound frontal skull fracture, so definitely left out for the prevention of infectious complications in the classic concept. The efficacy of primary replacement and resection of the injured bony fragments in the treatment of compound depressed frontal skull fractures was studied in 33 patients who could be followed up over one year during a recent 5-year period. The patients was divided into a group I which took a primary replacement of injured bony fragments and group II which left out the injured bony fragments in immediate operation. The results are summarized as follows 1) The age incidence was more frequent in the 3th and 4th decades. The sex distribution was more frequent in male(87%). 2) The motor vehicle accident was most frequent in the injury mechanism. 3) The conscious level on admission was 53% in 13~15 GCS group, 12% in 9~12 group, 26.6% in 6~8 group and 8.4% in 3~5 group. 4) The incidence of an extending fractures was 42% to orbital roof, 35% into frontal sinus, 25% into cribriform plate and 16% into nasal bone. 5) The incidence of intracranial injury was 65% in dural laceration and 51% in cerebral laceration. Of cases of dural laceration the cerebral laceration was associated in 78%. 6) The time duration from injury to operation was under 12 hours in most cases(84%). 7) The incidence of a complication was 36.1% in total group, 27.7% in group I and 47.2% in group II. The infectious complication was not a significant difference between group I(14.9%) and group II(16.7%). In conclusion the infectious morbidity of which were most dangerous complications due to compound depressed frontal skull fractures was not a significant difference in two compared group. The author believe that immediate bone replacement for compound depressed frontal fractures with or without extension to frontal sinus, orbit, or cribriform plate os both practical and safe procesures.