![]() The skull can be divided into the calvarium and the skull base. A fracture of the calvarium (skull cap) is more common than one at the base of the skull. Skull fracture has been shown to be more common in children under the age of 2 years following head trauma. The incidence of skull fracture in children following head injury ranges from 2% to 20%, and further epidemiological study is needed for more accurate incidence and prevalence rates. Very few injuries are life-threatening or require neurosurgical intervention. Fortunately, the majority (80% to 90%) of head injuries can be classified as mild. Head injury is a very common presentation to the PED and is the most common cause of lethal trauma in children. A meta-analysis of 12 studies of skull fractures in abuse has shown a skull fracture to be a positive predictive value of 20.1% in suspected or confirmed abuse cases. This is particularly important in the non-mobile infant. A non-accidental injury is important for clinicians to identify in children who present with a head injury and subsequent skull fracture. Occasionally, depressed "ping-pong" fractures can occur in newborns due to injury at birth. Other causes can include motor vehicle accidents (MVA), sports-related injuries, or other direct blows to the head. Commonly, head injuries are caused by a fall. ![]() EtiologyĬauses of head injury and skull fracture can be separated into accidental and non-accidental injuries. Generally speaking, a child's skull is thinner and more pliable, thus providing less protection to the brain. This will decrease to roughly 9% by adulthood. A child's head size is approximately 18% of the total body surface area in infancy. Children are more susceptible to head trauma and skull fracture than adults. Head trauma can result in a skull fracture and is a common cause of morbidity and mortality in children. It is a regular presentation in the Paediatric Emergency Department (PED) and primary care.
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