Skull Fracture

Topic Overview

A skull fracture is a break in one of the bones of your head. A fracture may be a hairline crack, or it can be what is called a depressed fracture. A skull fracture can injure the brain. Bacteria can enter the skull and may cause an infection if you have a cut in the skin over a skull fracture. Because a cut on the head can bleed so much, you may not be able to tell if you have a skull fracture.

Skull fractures can be caused by falls, by penetrating injuries from external objects, (such as gunshot wounds or wounds from knives, hammers, or axes), or as the result of the skull forcefully hitting a solid object. A brain injury may be present with a skull fracture. The fracture can help provide clues about the area of the brain injured and the severity of the injury. It also creates a pathway for infection if bacteria enter the inside of the skull.

Clear fluid leaking from the nose or ears after a head injury may be the fluid that surrounds the brain and spinal cord (cerebrospinal fluid, or CSF). If the skull is fractured and the covering of the brain (meninges) is torn, this fluid may drain out through the ears or nose. This type of drainage is not the same as the typical nasal drainage that occurs with allergies, cold symptoms, or crying. The drainage may indicate a fracture at the front of the skull (frontal bone), at the base of the skull (sphenoid or temporal bone), or of the bones that support the nose and sinuses (ethmoid bones).

Bruising or discoloration that develops within 24 hours after a head injury may be caused by a fracture at the base of the skull (basilar skull fracture). A basilar skull fracture often occurs with bleeding within the skull and may lead to an infection. Bleeding from the ears or the nose that is not caused by a cut or a direct blow may indicate a fracture of the base of the skull. Wash the blood from the cut and surrounding area to help determine if the bleeding is coming from a cut in that area. Signs of a basilar skull fracture may appear as bruising behind one ear (Battle's sign) or bruising around both eyes (raccoon eyes).

A visit to a doctor is needed to determine the source of the bleeding that is coming from deep inside the ear.

Try home treatment to stop a nosebleed that occurs after a head injury. A nosebleed that does not stop with home treatment may indicate a skull fracture.

Credits

Author Jan Nissl, RN, BS
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Tracy Landauer
Primary Medical Reviewer William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Last Updated July 9, 2008

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