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TYPES OF SKULL FRACTURE

Article · May 2014

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Raktim Tamuli
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 TYPES OF SKULL FRACTURE

Raktim Pratim Tamuli,

Demonstrator, dept. of Forensic Medicine& Toxicology, Tezpur Medical College, Tezpur, Assam
Email: raktimt81@gmail.com
Abstract:
Head accommodates one of the most vital parts of the body, the brain. Although it is well protected in a bony cranial
cage, it still remains one of the most vulnerable parts of the body. A fracture can be defined as an abnormal break in
the continuity of a structure such as a bone produced by stress and strain”. Out of all fractures, skull fractures draw
attention of doctors as vital structure like brain lies inside the skull.
Present author reports the various skull fractures encountered during medico legal autopsies in the mortuary of
Gauhati Medical College.
Fractures of the skull are commonly seen in Road Traffic Accident (RTA), and following blunt force impacts
injuries.
Key words: fracture; medico legal autopsy; RTA.

Introduction: a depressed zone, or arise under or at a distance

Head accommodates one of the most vital parts
of the body, the brain. Although it is well
protected in a bony cranial cage, it still remains
one of the most vulnerable parts of the body.
Head injury, a common term that is actually
cranio-cerebral damage, has been recognized
since ages. In medico-legal practice blunt head
injuries are most frequently caused by traffic
accident, fall from height, assault, train accident
etc. The manner of death in cases of cranio-
cerebral trauma may be accidental, homicidal or
suicidal. Accidental deaths are by far the most
common and road traffic accidents are the main
component, followed by falls from height and
railway accidents. Of all regional injuries, those
of the head and neck are the most common and
important in forensic practice.
After trauma, lesions such as skull fractures and
cerebral injuries may develop. A fracture can be
defined as an abnormal break in the continuity
of a structure such as a bone produced by stress
and strain”. Out of all fractures, skull fractures
draw attention of doctors as vital structure like
brain lies inside the skull1.
Here, the present author reports the various skull
fractures encountered during medico legal
autopsies at the mortuary of Gauhati Medical
College.
Linear fracture:
These are straight or curved fracture lines, often
of considerable length. About 70% of skull
fractures are linear2.They either radiate out from
from the impact area, from bulging deformation.
Also known as “Fissured fractures”; these are
linear cracks without any displacement of the
fragments and may involve whole thickness of
the bone or one or the other table only. They are
notoriously difficult to be detected and may not
be demonstrable by X-rays; can be visualized
with the help of a cranial Computed
Tomography (CT) scan3. These fractures are
presumed as a one-dimensional injury.
A fissured fracture which involves only one
table of the skull is referred to as a crack
fracture. It is usually the inner table which
fractures in such cases, since it is more brittle
than the outer one4.
Depressed fracture:
This occurs due to forceful localized impact
causing multiple linear fractures radiating from
the site of impact with depression of the site of
impact where the bone breaks into pieces.
Rarely, only the inner table may get fractured
and the outer remaining intact and vice versa
may also be true. A violent blow with full
striking area in operation, such as with a
hammer, may detach almost the same diameter
of the bone, which is driven inwards, thus often
producing a pattern consistent with the
offending object. This is why these fractures are
also called “Fractures a la Signature” or
“Signature fractures”2,5. This type of fracture
may also occur in case of primary impact by a
vehicle. In such case, from the size and shape of

NMO Journal (ISSN(Print)- 2348-3806) Vol. : 8 No.: 2 May-August 2014 1

the fracture, part of the vehicle striking the head rammed into the skull, carrying a circle of
can be known6. occipital bone with it 6.
Impacts with axe or chopper etc, may leave This is also known as the Foramen Fracture.
characteristic lesions in the bone, whether skull
or elsewhere. The shape of the fracture produced Hinge fracture:
by such weapons may, to some degree, reveal This is a fracture of base of the skull where the
the direction from which the blow was struck. fracture line runs from side to side across the
This is particularly true when a chopping middle cranial cavities separating the base into
instrument is used. The undermined edge of the two halves, anterior and posterior.
fracture defect is the direction in which the It is also known as the Motorcyclist’s fracture.
lateral force vector is exerted and the slanted
edge is the side of force transmission. Basilar fracture:
Basilar skull fractures are linear fractures that
Comminuted fracture: occur in the floor of the cranial vault (skull
The term “comminution” refers to fracture base), which require more force to cause than
division of a bone into several fragments. This other areas of the neurocranium. Thus they are
results when a considerable force is applied over rare, occurring as the only fracture in only 4% of
a relatively small area. Weapon with small severe head injury patients7.
striking surface like hammer are often the
causative object. Comminution can also be a
complication of fissured fractures.
Comminution fractures can be with or without
depression of the affected area. The former is
called Depressed Comminuted Fracture, while
the latter is referred to as Non-depressed
Comminuted Fracture4.
When there is no displacement of the
comminuted fragments, the area looks like
Spider’s web or Mosaic, with fissured fractures
radiating for varying distances along line of
dissipation of the forces2.

Diastatic fracture: Figure 1 Fissured fracture

Diastatic factures are those in which the fracture
line involves separation of one or more cranial
sutures. These are most often seen in children
and are commonly associated with epidural
haemorrhage. It may occur alone but often is
associated with other fractures. It is usually seen
in the sagittal suture. They are particularly
common in traffic accidents2, 5.

Ring fracture:
These occur in the posterior fossa around the
foramen magnum and are most often caused by
a fall from a height onto the feet. If the kinetic
energy of the fall is not absorbed by fractures of
the legs, pelvis or spine, the impact is
transmitted up the cervical spine. This may be Figure 2 Depressed comminuted fracture

NMO Journal (ISSN(Print)- 2348-3806) Vol. : 8 No.: 2 May-August 2014 2

 Figure 3 Signature fracture. Figure 6 Motorcyclist’s fracture

Figure 4 Comminuted fracture. Figure 7 Basilar fracture.

Figure 5 Diastatic fracture Figure 8 Ring fracture

NMO Journal (ISSN(Print)- 2348-3806) Vol. : 8 No.: 2 May-August 2014 3

Conclusion:
Out of all the fractures, fracture of skull draws
more attention of the physicians (neuro-
physicians), since there is always possibility of
injury to the underlying brain. Like other
fractures in the body, it does not show any callus
formation; so it difficult to diagnose an old skull
fracture by x-ray. These are commonly found in
Road Traffic Accidents and they are the
indicator of substantial insult to the head with
possible injury to the vital contents being a
danger to life.
References:
1. Oehmichen M, Auer RN, Konig HG.
Forensic Neuropathology and Associated
Neurology.Germany: Springer; 2006. p.116-
7.
2. Reddy KSN. The Essentials of Forensic
Medicine and Toxicology. 29 th ed.
NMO Journal (ISSN(Print)- 2348-3806) Vol. : 8 No.: 2 May-August 2014
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Hyderabad: K. Suguna Devi; 2010. p. 218-
38. (22)
3. Russel RCG, Williams NS, Bulstrode CJK,
editors. Baily & Love’s Short Practice of
Surgery. 23 rd ed. London: Arnold Publisher;
2003. p. 548-9. (23)
4. Pillay VV. Textbook of Forensic Medicine &
Toxicology. 16th ed. Hyderabad: Paras
Publisher; 2011. p. 205-16. (24)
5. Vij K. Textbook of Forensic Medicine and
Toxicology. 4th ed. Noida: Elsevier; 2009. p.
351-70.
6. Saukko P. Knight B. Knight’s Forensic
Pathology. 3rd ed. London, Arnold Publisher
2004. p 174-221 (1,20).
7. Skull fracture [online]. [Cited on 27 th
December, 2013, 5.30PM]. Available from
URL
http://en.wikipedia.org/wiki/Skull_fracture.
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