Elevated Skull Fractures: an Under-Recognized Entity

Elevated skull fractures form a rare subset of compound skull fractures. Owing to the paucity of cases studied and reported, these fractures still remain an under-recognized entity. We attempt to highlight the incidence of these relatively rare presentations of head injury. We had prospectively studied eight cases of elevated skull fractures in a mixed population of adults (five patients) and pediatric age group (three patients). Patients were evaluated in terms of clinical presentation, mode and mechanism of injury, treatment options, and final outcome, highlighting the appropriate management strategies taken in each case. The injury in these patients was due to tangential impact of a heavy object or assault weapon. Compounding of the fracture externally and dural tears was an inconstant feature. Associated intracranial injuries were cerebral contusions and extradural hematomas. An initial conservative therapy was given to all pediatric patients while adult patients underwent explorative craniectomy and evacuation of hematoma. Although an unusual presentation of skull fractures, elevated skull fractures warrant an early diagnosis, careful clinical evaluation, and prompt surgical therapy (whenever needed) for a successful outcome.