Operation of pediatric depressed skull fracture

Objective To investigate the application of two kinds of operation methods, drilling and prising elevation technique and trans-craniotomic elevation technique, in the treatment of the depressed skull fracture of pediatric patients. Methods We retrospectively evaluated pediatric patients with depressed skull fracture from January 2013 to December 2015 treated by neurosurgery approach in our hospital. There are 66 cases meet standard, male are 42 cases and female are 24 cases, which the ages range from 1 month to 13 years (mean interval: 3.71 years). We evaluated these cases from age, sex, mechanism of injury, location, surgery method and follows. Comparision was made between individuals who were treated by drilling and prising elevation technique (group A, n=33), and those surgically treated by trans-craniotomic elevation technique (group B, n=33). χ2 test and rank-sum test was used in this study. There are significantly different when P<0.05. Results In these cases, Fall and traffic accident are two main mechanisms of injury: Fall (18 cases, 27.3%), traffic accident(18 cases, 27.3%). There are significantly deferent in the mechanisms between <1 year group, 1-6 years group and 6-13 years group (χ2=15.349, P<0.05). Fall and violence are significantly deferent between these groups (P<0.01); the population of fall in the <1 year group is significant more than 1~6 years group(P<0.01). Parietal bone is the highest rate of injuries location (31 cases), the other two high rate of injuries location are temporal bone and frontal bone. There is no deferent in sex between group A (drilling and prising elevation technique) and group B (trans-craniotomic elevation technique) (χ2=2.262, P=0.609). The age at the time of evaluation was significantly younger in A group(Median(IQR): 0.92(2.92) years, P<0.001) compared with B group (Median(IQR): 5(4.54) years). Conclusion The drilling and prising elevation technique is recommended for the depressed skull fracture of pediatric patients younger than 2 years old and injury short than 2 weeks, who are simple depressed skul fractures or complicated with less significant epidural hematoma. Key words: Pediatric; Depressed skull fractures; Drilling and prising elevation technique; Trans-craniotomic elevation technique; GCS