Rational management of simple depressed skull fractures in infants

Object. The management regimen for depressed skull fractures in infants can be conservative or surgical. The aim of this study was to provide a rational principle of management for simple depressed skull fractures in infants. Methods. A protocol of nonsurgical treatment for a simple depressed skull fracture was designed for all affected infants during the period from 1985 to 2001. Conservative management was used for those with a depressed fracture measuring less than 5 mm in depth, whereas vacuum extraction was applied for larger and deeper depressions. All of the patients were evaluated for initial results and later outcomes. Twenty-five infants suffering simple depressed skull fractures were consecutively enrolled. According to our protocol, 11 patients received conservative management by close observation only. Spontaneous restoration of the depression was observed in eight patients within a period of 1 to 6 months. For the remaining 14 patients, vacuum extraction was performed. A negative pressure of 0.3 to 0.8 kg/cm 2 (mean 0.49 kg/cm 2 ) was applied for a duration of 20 to 90 seconds (mean 43.6 seconds). All but one patient experienced complete recovery following extraction. The depressions of the four patients that were residual after initial management smoothed out with time. No neurological deficit or later epilepsy was noted in any patient. Conclusions. Nonsurgical management can be the treatment of choice for infants with simple depressed skull fractures, whereas vacuum extraction is one option for larger and deeper depressions to obtain prompt resolution and relieve major family anxiety, without taking additional risks.