Outcome of primary bone fragment replacement in compound depressed skull fractures.

OBJECTIVE: To assess the outcome in terms of infectious complications after primary bone fragment replacement in compound depressed skull fractures, regardless of the degree of wound contamination. DESIGN: Case series. PLACE AND DURATION OF STUDY: Combined Military Hospital, Rawalpindi, from August 2005 to October 2006. PATIENTS AND METHODS: Patients of all ages and both genders with compound depressed skull fractures irrespective of the degree of wound contamination were selected. Patients with already infected skull wounds were excluded. Bone fragments were replaced in all cases. Main outcome variables were age, associated CT scan findings, type of fracture, location of fracture, wound type, admission to operation time, interval and infectious complications after surgery. RESULTS: Of the 51 cases, the wounds were classified as clean in only 9 patients and the rest had variable degrees of contamination. Thirty five patients were operated within 24 hours, 13 were debrided and bone fragments replaced within 24-72 hours and 3 patients were treated after 72 hours. Thirty five patients were earthquake victims. The average age of the patients was 28.6 years. Three patients developed wound infection and osteomyelitis. One patient had free-floating bone fragments due to the development of hydrocephalus with no evidence of infection. CONCLUSION: Bone fragment removal in compound depressed skull fractures, regardless of the degree of wound contamination, is not obligatory and primary bone fragment replacement is a suitable alternative, which also avoids a second cranioplasty.