Discussion Author: James George Smirniotopoulos, M.D.
Depressed skull fractures often occur when there is a small contact surface, as in a hammer strike. Because of displacement, the fracture lucencies are usually larger than with linear skull fractures. Most importantly for differential diagnosis, the edges of the depressed fragments may overlap the non-displaced bone, creating a dense line instead of the typical lucency of a fracture. A dense fracture line is virtually pathognomonic for a depressed fracture. With intact dura these are still considered to be closed head trauma. If the dura is torn, they are open skull fractures.
Depressed skull fractures may be associated with intracranial hemorrhage - both extraaxial and parenchymal (contusion and hematoma) - and communication with the outside can create pneumocephalus. Contusions underlying a fracture are often described as "fracture contusions" - a more specific term than coup contusions, that may result from closed head trauma.
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