Open cranial fractures, clinical manifestations vary greatly

Open craniocerebral fracture is a craniocerebral injury caused by external factors, common of which include blunt force injuries, falls, and injuries from falling. The patient will experience symptoms of shock and some disturbances of consciousness. It requires timely treatment and severe cases require surgical treatment.

1. Wound manifestation

In severe cases, the wound may split, the skull may be shattered and exposed, and rotten brain tissue and cerebrospinal fluid may overflow; in mild cases, the local wound may be very small and covered by the hair, making it difficult to find. During the inspection, attention should be paid to the size, direction and depth of the wound. Objects left in the wound should not be easily removed to avoid bleeding.

2. Systemic symptoms

Shock and changes in vital signs may occur in the early stages. The causes of shock include: scalp laceration and bleeding due to rupture of large intracranial arteries and veins; open craniocerebral injury with leakage of brain tissue and cerebrospinal fluid, and no obvious increase in intracranial pressure, so the compensatory increase in systemic blood pressure caused by increased intracranial pressure is reduced; and combined injuries leading to bleeding in other organs. Common complex injuries are mostly closed chest and abdominal injuries. If the craniocerebral injury is severe, the clinical signs are mostly dominated by brain injury, and complex injuries are easily missed. In addition, open craniocerebral injury may cause low fever, while wounds or intracranial infection may cause high fever, and positive meningeal irritation signs can be used for differentiation.

3. Symptoms of brain damage

Patients with open head injury often have varying degrees of impaired consciousness, but not as severe as those with closed head injury. The increase in intracranial pressure is often not obvious, but it may also be obvious when it is complicated by intracranial hematoma, intracranial infection, cerebral contusion, and severe cerebral edema. Focal symptoms may occur when important functional areas of the brain are damaged; when important structures such as the brainstem or hypothalamus are damaged, the clinical manifestations are severe and the prognosis is poor. The incidence of epilepsy in open head injury is higher than that in closed head injury.