Indian Journal of Neurotrauma 2009; 06(01): 43-47
DOI: 10.1016/S0973-0508(09)80025-7
Original article
Thieme Medical and Scientific Publishers Private Ltd.

Compound head injury in 46 pediatric patients

Raj Kumar
,
Arun Kumar Shrivastava
,
Udit Singhal
,
Bharti Saraswat
*   Department of Neurosurgery, Sampoornanand Medical College, Jodhpur (Rajasthan)
,
Ashok Kumar Mahapatra
› Author Affiliations

Subject Editor:
Further Information

Publication History

Publication Date:
05 April 2017 (online)

Abstract

The purpose of the present retrospective study was to analyze the pediatrics patients with compound head injury (CHI), and evaluate the incidence of complication in our setup, and to assess the various factors responsible for the ultimate outcome. During the 17-year-period (1990 to 2007), 46 pediatric patients under the age of 20 years with CHI were managed in two departments. The detailed clinical profile and radiological finding of these children were noted. Male to female ratio was 4.7:1. Mean age was 12.3 years. Major mode of trauma was road traffic accident; other causes included assault, fall from the height and missile injuries etc. Out of total 46 patients, 29 patients (64%) were treated surgically and 17 (36%) were managed conservatively. Complications were observed in 13 patients (29%). Meningitis was the most common, diagnosed in 6 cases (12%). Good recovery was observed in 20 cases (43%). Six children (13%) were moderately disabled, twelve (26%) were severely disabled and eight (17%) died. CHI has the risk of complications i.e. meningitis, seizure, CSF leak etc. Dural tear, free bone fragments and late presentation (more than 8 hours after trauma) were the important risk factors. Early surgery and adequate debridement with antibiotic cover play an important role in reducing the complication rate in children with compound head injury.

 
  • References

  • 1 Raja IA, Vohra AH, Ahmed M. Neurotrauma in Pakistan. World J Surg 25 2001; 1230-1237
  • 2 Rehman L, Ghani E, Hussain A, Shah A, Noman MA. Khaleeq-uz-zaman. Infection in compound depressed fracture of the skull. J Coll Physicians Surg Pak 17 2007; 140-143
  • 3 Miller JD, Jennett WB. Complications of depressed skull fracture. Lancet 02 1968; 991-995
  • 4 Braakman R. Depressed skull fracture: data, treatment and follow-up in 225 consecutive cases. J Neurol Neurosurg Psychiatry 35 1972; 395-402
  • 5 Ersahin Y, Mutlur S, Mirzai H, Palali I. Pediatric depressed skull fractures: analysis of 530 cases. Childs Nerv Syst 12 1996; 323-331
  • 6 Blankenship JB, Chadduck WM, Boop FA. Rapair of compound depressed skull fractures in children with replacement of bone fragments. Pediatric Neurosurg 16 1990- 1991; 297-300
  • 7 Shokunbi MT, Komolafe EO, Malomo AO, Amanor-Boadu DS, Sanusi A, Olumide AA. et al Scalp closure without fracture elevation does not reduce the risk of infection in patients with compound depressed skull fractures. Afr J Med Sci 29 2000; 293-296
  • 8 Al-Haddad SA, Kirollos R. A 5-year-study of the outcome of surgically treated depressed skull fractures. Ann R Coll Surg Engl 84 2002; 196-200
  • 9 Mlay SM, Sayi EN. The management of depressed skull fraxctures in children at Muhimbili Medical Centre, Dar es Salaam, Tanzania. East Afr med J 70 1993; 291-293
  • 10 Akram Maqsood, Ahmed Ishfaq, Qureshi Nazeer Ahmed, Sabir H. Bhatti and Asmim Ishfaq; outcome of primary bone fragment replacement in compound depressed skull fractures. J Coll Phy Surg Pak 17 2007; 744-748
  • 11 Jamieson KG, Yelland JDN. Depressed skull fracture in Australia. J Neurosurg 37 1972; 150-165
  • 12 Miura FK, Plese J P, Ciquini Junior O, Martinez JA, Matushita H. Depressed skull fractures in children under 2 years of age. Retrospective study of 43 cases. Arq Neurospiquiatr 53 1995; 644-648
  • 13 Jennett B., Miller D. Infection of depressed fracture of skull. J Neurosurg 36 1972; 333-339
  • 14 Steinbok P, Flodmark O, Martens D, Germann ET. Management of simple depressed skull fractures in children. J Neurosurg 66 1987; 506-510
  • 15 Sande GM, Galbraith SL, Mclatchie G. Infection after depressed fracture in the west of Scotland. Scot Med J 25 1980; 596-600
  • 16 Oh S. Clinical and experimental morphological study of depressed skull fracture. Acta Neurochir (Wien) 68 1983; 111-121
  • 17 Nee PA, Hadfield JM, Yates D W, Faragher EB. Significance of vomiting after head injury. J Neurol Neurosurg Psychiat 66 1999; 470-473
  • 18 Le Feuvre D, Taylor A, Peter JC.. Compound depressed skull fractures involving a venous sinus. Surg Neurol 62 2004; 121-125 discussion 125–6
  • 19 Van Den Heaver C Mauritz. Management of depressed skull fracture selecative conservative management of non-missile injuries. J Neurosurg 71 1989; 186-190
  • 20 Ostermann PA, Henry SL, Seligson D. The role of local antibiotic therapy in the management of compound fractures. Clin Orthop Relat Res 295 1993; 102-111
  • 21 Marion DW. Complications of head injury and their therapy. Neurosurg Clin North Am 02 1991; 411-424
  • 22 Hegan RE. Early complications following penetrating wounds of brain. J Neurosurg 34 1971; 132-140
  • 23 Taha JM, Haddad FS, Brown JA. Intracranial infection after missile injuries to the brain. Report of 30 cases. Neurosurgery 29 1991; 868