Fracture, skull

• See end of entry for full list
• 803 Other and unqualified skull fractures
  • 803.0 Other closed skull fracture without mention of intracranial injury
  • 803.1 Other closed skull fracture with cerebral laceration and contusion
  • 803.2 Other closed skull fracture with subarachnoid subdural and extradural hemorrhage
  • 803.3 Closed skull fracture with other and unspecified intracranial hemorrhage
  • 803.4 Closed skull fracture with intracranial injury of other and unspecified nature
  • 803.5 Other open skull fracture without mention of intracranial injury
  • 803.6 Other open skull fracture with cerebral laceration and contusion
  • 803.7 Other open skull fracture with subarachnoid subdural and extradural hemorrhage
  • 803.8 Other open skull fracture with other and unspecified intracranial hemorrhage
  • 803.9 Other open skull fracture with intracranial injury of other and unspecified nature

• 5C: Impaired Motor Function and Sensory Integrity Associated With Nonprogressive Disorders of the Central Nervous System - Congenital Origin or Acquired in Infancy or Childhood
• Pattern 5D: Impaired Motor Function and Sensory Integrity Associated With Nonprogressive Disorders of the Central Nervous System - Acquired in Adolescence or Adulthood

Description

• Defined as external trauma to the skull that results in damage to one or more parts of the brain
• Fracture of the skull
  • Open head injury (penetrating): fracture of the skull with brain injury
  • Closed head injury (blunt, non-penetrating): skull remains intact, but brain injury is evident.
• Depressed skull fracture: break in a cranial bone with depression toward the brain
• Linear skull fracture: break in a cranial bone, thin line without splintering, depression, or distortion of the bone
• Initial presentation will range from comatose to ambulatory and verbal depending on the extent and location of damage

Essentials of Diagnosis

• Damage to the brain may result in changes or dysfunction to any body functions including:
  • Motor loss
  • Sensory loss
  • Autonomic dysfunction
  • Perceptual changes
  • Cognitive, personality, and behavioral changes
  • Changes in consciousness
  • Communication difficulties
  • Eating, swallowing, bowel, and bladder changes

General Considerations

• Delayed effects of the trauma are common.
• Full extent of the injury is not known at the time of injury.
• Intracranial swelling must be addressed/controlled before the full extent of the damage can be identified.
• Swelling will cause secondary damage to parts of the brain that were not impacted by the initial trauma.
• Cerebral hypoxia and/or ischemia, cerebral hemorrhages, electrolyte imbalances, infections from open wounds/open head injury, and seizures are common.
• Physical activity is contraindicated until the full effects of the brain injury are known and the patient has stable intracranial pressures.

Demographics2

• American Trauma Society estimates approximately 500,000 people are admitted to the hospital each year in America due to cerebral trauma; 75-90,000 die from the cerebral trauma, and many others remain permanently disabled.
• Most commonly injured are between the ages of 15 and 24 years
• Men are twice as likely as women to suffer a brain injury.
• Leading ...