Skull Fractures (Nursing)

00:00 Now when it comes to fractures, you can have compound or displaced.

00:04 These are just terms that you'll hear when you're caring for patients.

00:08 So I want you to understand the vocabulary that we use to talk about traumatic brain injuries.

00:13 So, compound is occurring with an open wound.

00:17 Just like if we talked about a compound leg fracture, we're talking about a compound skull fracture, it's occurring with an open wound.

00:23 Displaced is a closed wound, but the end of the fractures no longer meet.

00:29 So, think about that being in your skull, it's not open, but the skull doesn't....

00:34 The skulls experienced a fracture and the ends don't meet anymore.

00:38 So, instead of this, I have this.

00:41 Okay, so that's going to give us potentially some problems depending on how bad or difficult that injury was.

00:47 Okay, so the linear in skull fractures are the most common type and they're also usually the least problematic.

00:56 Look at the graphic drawing there.

00:58 We've shown you what a skull fracture would look like and you also see in the close-up picture how that just a little tiny crack.

01:04 They shouldn't be that big a problem.

01:06 It's the most common type that we see.

01:08 It's a break in the bone, but it doesn't move the bone.

01:12 And usually we don't do much for it beyond just keeping an eye on the patient, seeing if they have any additional problems.

01:18 Now you wouldn't wish this on anyone because something traumatic happened to their head, but it shouldn't be that big of a problem.

01:27 This one...

01:28 Ouch. Look at that.

01:31 You see where the arrow is pointing? They've got a divot in their skull, right? It makes me think when you golf and you get a big chunk of grass up.

01:37 So they've got like if I taken my thumbprint and...

01:40 Really pressed in on that.

01:42 So look at the close-up in the graphic. Can you see what you have there? There's the outside of the head.

01:47 Then you see how that skull is dented in.

01:50 Oh, there's some red stuff underneath there.

01:52 Yeah, likely it have some blood there right around the brain tissue.

01:58 So, in a depressed skull fracture, the bone is pressed into the dura.

02:03 Remember the dura are the really tough layer that covers the outside of the brain.

02:08 Now often these patients have to go to surgery, you have to kind of maybe try to elevate that bone.

02:13 Think of it like a dent in a car, we have to kind of get that out.

02:16 Well, the same thing for your skull.

02:18 So, it might have to go to surgery to elevate the bone.

02:20 You might need to debride the wound and you might need to repair the dura.

02:25 So, the linear fracture, not a big deal.

02:28 Depressed skull fracture, now we're getting more serious.

02:32 And depending on how big it is and where it is, the patient may need surgery for follow up.

02:37 Now, this one is a tongue-twister.

02:39 Diastatic skull fractures.

02:42 This is more common in older newborns and in infants.

02:46 Okay, so this is what you're going to see in little guys.

02:49 So, older newborns and infants often can have this kind of fracture because it happens along the skull suture lines and it widens them.

02:57 So, this is one that, hopefully, you don't see very often.

03:00 But if you do, know that it's going to be a fracture right along the suture line that causes that suture line to widen.

03:07 Now, remember, they don't have stitches in their skull.

03:10 That's just what we call the spaces where the skull is able to expand as they're growing.

03:15 That's what a suture line is.

03:17 Now, this is the one that's the biggest deal, okay? Basilar skull fracture.

03:25 So we're gonna hang out here for a little bit because it's really important that you recognize what this looks like and you look for the key signs that could happen.

03:33 So this is the most serious type of skull fracture is a basilar skull fracture.

03:38 It involves a break in the bone at the base of the skull.

03:42 Now take a look at that drawing.

03:45 See where you have the little arrow pointing in, you can see that fracture way down deep in there.

03:51 That's a break or a fracture in the bone at the base of the skull.

03:56 This can lead to a really big problem.

03:59 And I'll help you understand why.