Growing skull fractures: Strategies for repair and reconstruction

Most skull fractures in growing children heal rapidly and without significant contour irregularity. Skull fractures in infants associated with dural injuries, however, may progressively enlarge as a result of bone erosion by leptomeningeal herniation at the dural tear sites and are known as 'growing skull fractures.' Over a 6-year period, seven growing skull fractures occurred in a population of 592 consecutive pediatric head injuries at Cardinal Glennon Children's Hospital (prevalence, 1.2%). Prompt recognition of growing skull fractures, repair by regional craniectomy and pericranial dural inlay graft, and immediate contour reconstruction with rigidly fixed cranial bone graft ensure reliable aesthetic and functional restoration of the growing neurocranium.