A skull fracture is a fracture or break in the cranial (skull) bones. See also concussion.

Skull fractures may occur with head injuries. Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull. It may be accompanied by injury to the brain.

The brain can be affected directly by damage to the nervous system tissue and bleeding. It can be affected indirectly by blood clots which form under the skull, but compress the underlying brain tissue (subdural or epidural hematoma).

A simple fracture is a break in the bone without damage to the skin.

A linear skull fracture is a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone.

A depressed skull fracture is a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brain.

A compound fracture involves a break in, or loss of skin and splintering of the bone.

• Head trauma
• Falls, automobile accidents, physical assault, and sports

• Headache
• Bleeding from wound, ears, nose, or around eyes
• Drainage of clear or bloody fluid from ears or nose
• Loss of consciousness
• Confusion
• Convulsions
• Restlessness, irritability
• Drowsiness
• Slurred speech
• Difficulties with balance
• Visual disturbances
• Nausea
• Vomiting
• Swelling
• Bruising behind the ears or under the eyes
• Changes in pupils (sizes unequal, not reactive to light)
• Stiff neck

Note: The only symptom may be a bump on the head.

1. Check the airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.

2. Avoid moving the victim (unless absolutely necessary) until medical help arrives. Instruct someone to call 911 (or another emergency number) for medical assistance.

3. If the victim must be moved, take care to stabilize the head and neck. Place your hands on both sides of the head and under the shoulders. Do not allow the head to bend forward or backward, or to twist or turn.

4. Carefully check the site of injury, but do not probe in or around the site with a foreign object. It can be difficult to ascertain accurately if the skull is fractured or depressed (dented in) at the site of injury.

5. If bleeding, apply firm pressure with a clean cloth to control blood loss over a broad area.

6. If blood soaks through, do not remove the original cloth. Rather, apply additional cloths on top, and continue to apply pressure.

7. If the victim is vomiting, stabilize the head and neck, and carefully turn the victim to the side to prevent choking on vomit.

8. If the victim is conscious and experiencing any of the previously listed symptoms, transport to the nearest emergency medical facility (even if he does not think medical assistance is necessary).

• DO NOT move the victim unless absolutely necessary -- head injuries may be associated with spinal injuries.
• DO NOT remove protruding objects.
• DO NOT allow the victim to continue to engage in physical activities.
• DO NOT forget to observe the victim closely until medical help arrives.
• DO NOT give the victim any medications before consulting a physician.
• DO NOT leave the victim alone, even if there are no complaints or obvious injuries.

• Problems with breathing or circulation occur.
• Bleeding from the nose, ear(s), or wound does not stop with direct pressure.
• Drainage of clear fluid from the nose or ears.
• Facial swelling, bleeding, or bruising.
• There is an object protruding from the skull.
• The victim is unconscious, is experiencing convulsions, has multiple injuries, appears to be in any distress, or is not lucid.

1. Use car seats or seat belts whenever in a motor vehicle.

2. Use helmets whenever biking, skating, climbing, or playing contact sports.

3. Use equipment designed specifically for the type of sport or recreation in which you are participating.

4. Provide appropriate supervision for children of any age.

5. Do not allow children to bike or skate at night.

6. Provide highly visible clothing.

7. Teach children to obey traffic rules and signals.

8. Educate individuals about risks of various work, recreational, or sport activities and how to avoid injury.

Dias MS. Traumatic brain and spinal cord injury. Pediatr Clin North Am. 2004; 51(2): 271-303.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:306.

Kumar V, Abbas AK, Fausto N. Robbins and Cotran Pathologic Basis of Disease. 7th ed. St. Louis, Mo: WB Saunders; 2005:1357.