Patient education: Skull fractures (The Basics)

What is a skull fracture? — 

A fracture is another word for a broken bone. A skull fracture is when a person breaks their skull (head) (figure 1).

Skull fractures can happen when a person is hit hard on the head, like in a fall, car accident, or sports injury.

There are different kinds of fractures, depending on how the bone breaks. Some are more serious than others. If the bone edges are lined up ("linear"), the fracture is usually not as serious. But if part of the bone is pushed in toward the brain ("depressed"), the fracture is more serious.

In some cases, skull fractures can lead to serious problems, including:

●Brain damage

●Bleeding in or on top of the brain

●An infection of the tissues around the brain and spinal cord

●Seizures – These are waves of abnormal electrical activity in the brain. They can make people pass out, or move or behave strangely.

What are the symptoms of a skull fracture? — 

Symptoms can be mild or severe, depending on where the fracture is, how serious it is, and the injury that caused it. Possible symptoms can include:

●Pain, swelling, or bleeding where the injury is – Sometimes, it takes a day for the swelling to start.

●Headache

●Feeling very tired, confused, or dizzy, or passing out

●Bruising around the eyes or behind the ear

●Bleeding from the nose or ear

●Clear fluid draining from the nose or ear – This might be spinal fluid, which is the fluid that surrounds the brain and spinal cord.

●Vomiting

●Trouble smelling, hearing, or seeing

●Weakness or numbness of the face

Is there a test for a skull fracture? — 

Yes. The doctor will ask about your symptoms and injury, and do an exam. To look for a fracture, they can do a CT scan of the head. This is an imaging test that creates pictures of the skull and brain.

The doctor might also do an MRI or other imaging tests.

How are skull fractures treated? — 

Treatment depends on the type of fracture and where it is:

●Linear skull fracture – Many people do not need treatment if they don't have signs of brain injury or bleeding on a CT scan. They might be able to go home and not be admitted to the hospital.

The doctor will watch them to follow their symptoms for a few hours. If they don't develop any complications during this time, they can usually go home. But the doctor will probably recommend someone watch them at home for 24 hours to make sure their symptoms don't get worse.

People who have complications, are older, or take medicines that increase the risk of bleeding often need to stay in the hospital.

●Skull fracture with signs of a brain injury or bleeding – Most people with this type of injury need to stay in the hospital for a longer time. They often need care from a "neurosurgeon." This is a doctor who specializes in the brain and nerves.

Depending on the situation, these people might need:

•Surgery

•Treatments to lower the risk of bleeding

•Medicines to prevent seizures

●Depressed skull fracture – People with this type of injury often need surgery. A neurosurgeon will decide if the bone needs to be moved back into place. They will also do surgery if there are signs of a brain injury or bleeding below the fracture.

●Growing fracture – This type of skull fracture can happen in children younger than 3 years old. If there is a large gap between the bones, they might not heal properly. Many children with this type of fracture can go home from the emergency department if they don't have signs of a brain injury or bleeding on a CT. They need to follow-up with a neurosurgeon.

How do I care for myself at home? — 

To care for yourself or your child at home:

●Follow instructions for limiting activity and movement until your bone is healed. The doctor or nurse will tell you what activities are safe to do.

●Prop your head and shoulders on pillows, keeping it above the level of your heart. This might help lessen pain and swelling.

●Take all your medicines as instructed:

•The doctor might recommend you take an over-the-counter pain medicine. These include acetaminophen (sample brand name: Tylenol), ibuprofen (sample brand names: Advil, Motrin), and naproxen (sample brand name: Aleve).

•You might have gotten a prescription for an antibiotic, a medicine to prevent seizures, or stronger pain medicines to take for a short time. Follow all instructions for taking these.

●Ice can help with pain and swelling – Put a cold gel pack, bag of ice, or bag of frozen vegetables on the injured area every 1 to 2 hours, for 15 minutes each time. Put a thin towel between the ice (or other cold object) and your skin. Ice for at least 6 hours after the injury. It might help to ice longer, even up to 2 days.

●Eat a healthy diet that includes plenty of calcium, vitamin D, and protein (figure 2).

●Quit smoking, if you smoke. Your doctor or nurse can help. Broken bones take longer to heal if you smoke.

When should I call the doctor or nurse? — 

After a head injury, there are certain problems you or your caregiver should watch for.

Someone should call for an ambulance (in the US and Canada, call 9-1-1) if you:

●Are very sleepy (more than expected) or hard to wake up

●Are acting confused or disoriented

●Have vomiting that starts or continues more than 4 to 6 hours after the injury

●Have behavior changes like angry outbursts, strange behavior, or thoughts of hurting yourself or others

●Have trouble speaking, have slurred speech, or are not making sense when you talk

●Have blurry eyesight, double vision, or other vision problems

●Feel dizzy or faint

●Stumble or have trouble walking

●Seem weak or have numbness of your arm, leg, or other body part

●Have a seizure or jerking of your arms or legs you cannot control

Return to the ED if you:

●Have trouble concentrating, thinking clearly, or remembering things

●Have nausea or vomiting that is not improving

●Have a stiff neck

●Have a headache that gets worse, feels different, or does not get better with over-the-counter medicines

●Get a fever of 100.4°F (38°C) or higher, or chills

●Have blood or clear liquid draining from your ears or nose

How can I help prevent skull fractures? — 

You should:

●Wear a helmet when you ride a bike, skateboard, scooter, or motorcycle or play certain sports.

●Wear a hard hat and protective gear if you work in construction or a job where you work in a high place.

●Wear a seat belt every time you ride in a car.

●Teach children not to slide head-first on sleds or slides or when playing baseball. Follow all rules at water parks.

More on this topic

Patient education: Facial fractures (The Basics)
Patient education: Head injury in adults (The Basics)
Patient education: Head injury in children and teens (The Basics)
Patient education: Concussion in adults (The Basics)
Patient education: Concussion in children and teens (The Basics)
Patient education: Headaches in adults (The Basics)
Patient education: Headaches in children (The Basics)
Patient education: Moderate to severe traumatic brain injury (The Basics)
Patient education: Meningitis in children (The Basics)
Patient education: Vertigo (a type of dizziness) (The Basics)
Patient education: Seizures (The Basics)