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Compound Elevated Skull Fracture: A Report of Two Cases and Literature Review

Received: 23 May 2017     Accepted: 12 June 2017     Published: 23 August 2017
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Abstract

Elevated skull fracture unlike depressed skull fracture is rare with few cases reported in the literature. Some cases have been reported from the South-western part of Nigeria. The aim of this report is to present an unusual aetiology for compound elevated skull fracture and to highlight the need for proper imaging and careful examination under anaesthesia to identify any dura tear and institute appropriate care. This is a report of 2 cases with compound elevated skull fractures. The first patient is a 2 year old boy who sustained injury following contact with a rotating ceiling fan blade while he was being lifted up by his uncle. Whereas the other patient, a 45 year old man, had his injury inflicted following assault. Examination findings in both patients revealed scalp laceration. The first patient had no focal neurological deficit but the second patient had significant focal neurological deficit. CT scan in both patients showed elevated skull fracture and evidence of dura tear. Both patients were worked up for surgery and had craniotomy, wound debridement, duroplasty and primary wound closure. They have been doing well since discharge. In conclusion, a rotating fan blade making contact with the head with downward pull produced elevated skull fracture in young children. Early recognition and treatment of this type of fracture would reduce the morbidity and mortality and improve outcome.

Published in Journal of Surgery (Volume 5, Issue 4)
DOI 10.11648/j.js.20170504.13
Page(s) 68-71
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Compound Elevated Skull Fracture, Rotating Fan Blade, Assault, Machete

References
[1] Geisler FH. Skull fractures. In: Wilkins RH, Rengachary SS, editors. Neurosurgery vol II. New York: McGraw Hill; 1996. pp. 2741–2754.
[2] Breasted JH. The Edwin Smith Surgical Papyrus. Facsimile and hieroglyphic transliteration with translation and commentary, in two volumes. Chicago: University of Chicago Press; 1930.
[3] Sanchez GM, Burridge AL. Decision making in head injury management in the Edwin Smith Papyrus. Neurosurg Focus. 2007; 23 (1): 1–9.
[4] Ralston BL. Compound elevated fractures of the skull. Report of two cases. J Neurosurgery 1976; 44: 77-8.
[5] Verdura J, White RJ. Compound elevated skull fractures. J Neurosurg 1976; 45: 245.
[6] Adeolu AA, Shokunbi MT, Malomo AO, Komolafe EO, Olateju SO, Amusa YB. Compound elevated skull fracture: a forgotten type of skull fracture. Surg Neurol 2006; 65: 503-5.
[7] Borkar SA, Prasad GL, Gupta DK, et al. Compound elevated skull fracture: a clinical series of three patients with a review of the literature. Turk Neurosurg. 2013; 23 (4): 514.
[8] Borkar SA, Sinha S, Sharma BS. Post Traumatic compound elevated fracture of skull simulating a formal craniotomy. Turkish Neurosurg 2009; 19: 103-5.
[9] Bhaskar S. Compound "elevated" fracture of the cranium. Neurol India [serial online] 2010; 58: 149-51.
[10] Mohindra, S. and Singh, H. and Savardekar, A. Importance of an intact dura in management of compound elevated fractures; A short series and literature review Brain Injury. 2012; 26 (2): 194-198.
[11] Sharma, R. and Saligouda, P. and Bhat, D. I. and Devi, B. I. Compound elevated skull fracture mimicking a fronto temporo orbito zygomatic craniotomy flap. Neurology India. 2012; 60 (4): 448-449.
[12] Rajeev Sharma, Arun Kumar, Dhananjaya I. Bhat, B. Indira Devi. Compound elevated skull fractures in adults: A series of five patients and review of literature. The Indian Journal of Neurotrauma. 2012; 9 (2): 112.
[13] Sandeep Mohindra, Harnarayan Singh, Amey Savardekar. Importance of an intact dura in management of compound elevated fractures; A short series and literature review. Brain Injury. 2012; 26 (2): 194.
[14] Rakesh Gupta, Raghavan Iyengar, Akshat Kayal, Abhishek Songara. Elevated Skull Fractures: an Under-Recognized Entity. Indian Journal of Surgery. 2015; 77 (3): 1308-1312.
[15] Chhiber SS, Wani MA, Kirmani AR. Ramzan AU, Malik NK, Wani AA, Bhat A, Dhar A, Kanth A. Elevated skull fractures in pediatric age group: report of two cases. Turk Neurosurg 2011; 21 (3): 418–420.
[16] Abu Talha, Selvapandian S, Asaduzzaman K, Selina F, Rahman M, Riad M. Compound elevated skull fracture with occlusion of the superior sagittal sinus: A case report. Kobe J Med Sci 2009; 54 (5): 260-263.
Cite This Article
  • APA Style

    Sale Danjuma, Kache Stephen Akau, Obadaki Abubakar Michael, Johnson Ameh, Aghadi Ifeanyi Kene. (2017). Compound Elevated Skull Fracture: A Report of Two Cases and Literature Review. Journal of Surgery, 5(4), 68-71. https://doi.org/10.11648/j.js.20170504.13

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    ACS Style

    Sale Danjuma; Kache Stephen Akau; Obadaki Abubakar Michael; Johnson Ameh; Aghadi Ifeanyi Kene. Compound Elevated Skull Fracture: A Report of Two Cases and Literature Review. J. Surg. 2017, 5(4), 68-71. doi: 10.11648/j.js.20170504.13

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    AMA Style

    Sale Danjuma, Kache Stephen Akau, Obadaki Abubakar Michael, Johnson Ameh, Aghadi Ifeanyi Kene. Compound Elevated Skull Fracture: A Report of Two Cases and Literature Review. J Surg. 2017;5(4):68-71. doi: 10.11648/j.js.20170504.13

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  • @article{10.11648/j.js.20170504.13,
      author = {Sale Danjuma and Kache Stephen Akau and Obadaki Abubakar Michael and Johnson Ameh and Aghadi Ifeanyi Kene},
      title = {Compound Elevated Skull Fracture: A Report of Two Cases and Literature Review},
      journal = {Journal of Surgery},
      volume = {5},
      number = {4},
      pages = {68-71},
      doi = {10.11648/j.js.20170504.13},
      url = {https://doi.org/10.11648/j.js.20170504.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20170504.13},
      abstract = {Elevated skull fracture unlike depressed skull fracture is rare with few cases reported in the literature. Some cases have been reported from the South-western part of Nigeria. The aim of this report is to present an unusual aetiology for compound elevated skull fracture and to highlight the need for proper imaging and careful examination under anaesthesia to identify any dura tear and institute appropriate care. This is a report of 2 cases with compound elevated skull fractures. The first patient is a 2 year old boy who sustained injury following contact with a rotating ceiling fan blade while he was being lifted up by his uncle. Whereas the other patient, a 45 year old man, had his injury inflicted following assault. Examination findings in both patients revealed scalp laceration. The first patient had no focal neurological deficit but the second patient had significant focal neurological deficit. CT scan in both patients showed elevated skull fracture and evidence of dura tear. Both patients were worked up for surgery and had craniotomy, wound debridement, duroplasty and primary wound closure. They have been doing well since discharge. In conclusion, a rotating fan blade making contact with the head with downward pull produced elevated skull fracture in young children. Early recognition and treatment of this type of fracture would reduce the morbidity and mortality and improve outcome.},
     year = {2017}
    }
    

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  • TY  - JOUR
    T1  - Compound Elevated Skull Fracture: A Report of Two Cases and Literature Review
    AU  - Sale Danjuma
    AU  - Kache Stephen Akau
    AU  - Obadaki Abubakar Michael
    AU  - Johnson Ameh
    AU  - Aghadi Ifeanyi Kene
    Y1  - 2017/08/23
    PY  - 2017
    N1  - https://doi.org/10.11648/j.js.20170504.13
    DO  - 10.11648/j.js.20170504.13
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 68
    EP  - 71
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20170504.13
    AB  - Elevated skull fracture unlike depressed skull fracture is rare with few cases reported in the literature. Some cases have been reported from the South-western part of Nigeria. The aim of this report is to present an unusual aetiology for compound elevated skull fracture and to highlight the need for proper imaging and careful examination under anaesthesia to identify any dura tear and institute appropriate care. This is a report of 2 cases with compound elevated skull fractures. The first patient is a 2 year old boy who sustained injury following contact with a rotating ceiling fan blade while he was being lifted up by his uncle. Whereas the other patient, a 45 year old man, had his injury inflicted following assault. Examination findings in both patients revealed scalp laceration. The first patient had no focal neurological deficit but the second patient had significant focal neurological deficit. CT scan in both patients showed elevated skull fracture and evidence of dura tear. Both patients were worked up for surgery and had craniotomy, wound debridement, duroplasty and primary wound closure. They have been doing well since discharge. In conclusion, a rotating fan blade making contact with the head with downward pull produced elevated skull fracture in young children. Early recognition and treatment of this type of fracture would reduce the morbidity and mortality and improve outcome.
    VL  - 5
    IS  - 4
    ER  - 

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Author Information
  • Division of Neurosurgery Department of Surgery, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna, Nigeria

  • Department of Surgery, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna, Nigeria

  • Department of Surgery, St Gerard Catholic Hospital, Kaduna, Nigeria

  • Department of Surgery, Epsilon Specialist Hospital, Kaduna, Nigeria

  • Department of Surgery, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna, Nigeria

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