Management of simple depressed skull fractures in children.

Surgical elevation is the treatment usually recommended for a simple depressed skull fracture if the depression is more than the full thickness of the adjacent skull, but there is no clinical evidence to support this management. On that basis, a progressively more conservative approach to the treatment of this condition was adopted, especially in young children. Experience with this mode of management over the period 1972 to 1984 is presented. Of 111 patients under 16 years of age with depressed skull fractures, 64 had simple and 47 compound fractures. Simple depressed skull fractures occurred in a younger age group after less significant trauma than compound fractures. In those patients who were treated surgically, there was an 11% incidence of dural laceration in patients with simple depressed fractures versus 67% for the patients with compound depressed fractures. There was no difference in outcome between surgically and nonsurgically treated patients with simple depressed fractures with respect to the occurrence of seizures, neurological dysfunction, or cosmetic appearance. Surgical treatment prolonged hospitalization, and the only case with a fatal outcome was found in the group of patients treated surgically. It is suggested that the standard treatment of simple depressed skull fractures in the pediatric age group should not include surgery. Surgery is indicated when there is definite evidence of dural penetration and in the older child with an unacceptable cosmetic appearance.