Skull fractures in children: their assessment in relation to developmental skull changes and acute intracranial hematomas.

Retrospective analysis of 12,072 pediatric head injury cases revealed 1,297 skull fractures. Patients with skull fractures were divided into four age groups according to the fusion of skull sutures and other developmental radiological skull changes. Results revealed that the patients with open skull sutures (aged less than 2 years) and with linear skull fractures alone had a negligible chance of developing intracranial hematomas. With the fusion of metopic and mendosal sutures associated with other skull changes (greater than 2 years), the children became progressively more susceptible to developing intracranial hematomas if they had a skull fracture. The risk of developing intracranial hematomas was the highest among those patients (much greater than 11-15 years) whose paranasal sinuses had reached adult size and spheno-occipital synchondrosis had begun to fuse.