Abstract
Background Depressed skull fractures have been well described since antiquity, yet its management
remains controversial. Contentious issues include the use of prophylactic antibiotics
and antiepileptics, the role of nonoperative management, and the replacement/removal
of bone fragments. Our objective was to explore the management patterns of closed
and open depressed skull fractures across the world.
Methods A 23-item, web-based survey was distributed electronically to the members of national
neurosurgical associations, and on social media platforms. The survey was open for
data collection from December 2020 to April 2021.
Results A total of 218 respondents completed the survey, representing 56 countries.With regard
to open fractures, most respondents (85.8%) treated less than 50 cases annually. Most
respondents (79.4%) offered prophylactic antibiotics to all patients with open fractures,
with significant geographical variation (p < 0.001). Less than half of the respondents (48.2%) offered prophylactic antiepileptics.
Almost all respondents (>90%) reported the following indications as important for
surgical management: (1) grossly contaminated wound, (2) dural penetration, (3) depth
of depression, and (4) underlying contusion/hematoma with mass effect. Most respondents
treated less than 50 cases of closed depressed skull fractures annually. Most European
respondents (81.7%) did not offer prophylactic antiepileptics in comparison to most
Asian respondents (52.7%; p < 0.001). Depth of depression, an underlying hematoma/contusion with mass effect,
and dural penetration were the most important surgical indications.
Conclusions There remains a great degree of uncertainty in the management strategies employed
across the world in treating depressed fractures, and future work should involve multinational
randomized trials.
Keywords
depressed skull fractures - compound depressed skull fractures - traumatic brain injury
- online survey - cross-sectional study
