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A clinical investigation of the mechanism of growing skull fractures in children

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Author:
No author available
Journal Title:
Chinese Journal of Neurosurgery
Issue:
10
DOI:
10.3760/cma.j.issn.1001-2346.2012.10.010
Key Word:
颅骨生长性骨折;儿童;外科手术;发病机制;Growing skull fracture;Child;Surgical procedures,operative;Mechanism

Abstract: Objective Many theories have been offered to explain growing skull fractures (GSFs),such as dural tears,arachnoid herniation,increased intracranial pressure,bone absorption due to the ischemia of the fracture line,and delayed or ceased bone growth.These theories,however,are limited by certain inadequacies.In this prospective study,we sought to uncover the mechanisms of GSFs,and their treatment method in children.Methods Ten patients with GSFs who received treatment at our hospital between November 2000 and June 2010 were retrospectively analyzed.The age at injury,duration from the time of injury to the appearance of the GSFs,fracture width,and imaging characteristics were analyzed.Cranioplasty was carried out,while duraplasty was not performed.Results The age at injury ranged from 2 to 21 months,and the age at surgery ranged from 3 to 5 years.The injuries included 7 fail injuries and 3 automobile collision injuries.All were linear skull fractures.The duration from the time of injury to the appearance of a GSFs was < 1 month in 4 cases and < 2 months in 6 cases.Six patients had frontal bone fractures,2 had parietal bone fractures,and 2 had occipital bone fractures.The fracture width ranged from 1.5 to 2.5 cm.The growing fractures became stationary just after the onset,without further progression.Computed tomography (CT) revealed 4 cases of encephalocele underneath the fracture and 6 cases of encephalomalacia due to brain contusion.Follow - up ranged from 1 to 7 years.Titanium plate fixation was stable,without loosening or displacement.There were no skull deformities in any patient.Conclusion GSFs usually occur in young children.The dural tear and the rapid growth of the brain in young children produce an outward expansion force,which plays a crucial role in GSFs development.It is possible that the current theories such as arachnoid herniation,increased intracranial pressure,bone absorption due to ischemia of the fracture line,and delayed or ceased bone growth only constitute secondary causes.

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