Growing Skull Fractures

Growing skull fractures are rare. They almost always occur in children younger than 3 years of age. The inciting injury is often relatively severe, and associated neurological disability is common. Skull radiographs obtained soon after injury demonstrate fracture diastasis more than 3.5 mm, and CT often shows injury to the underlying brain. A pulsatile, subgaleal collection is frequently present. If untreated, the ossification defect often widens over the ensuing weeks and months. Once the diagnosis is clear, operative repair is indicated. A large craniotomy is often required because the dura can retract several centimeters from the bone edge; identification and repair of the dural defect is required if recurrence is to be avoided. If unrepaired, growing fractures can continue to enlarge and secondary brain injury and dysfunction can occur.