Depressed Skull Fracture — CT Brain (Non-contrast)
Key radiological features:
1. Bony Abnormality
- Inward displacement of skull fragment(s) below adjacent inner table
- Step defect in calvarium
- Often comminuted fragments
- Best seen in bone window
2. Depth Criteria (Clinical relevance)
- Depression > thickness of adjacent skull → significant
- Associated with higher risk of dural tear & brain injury
3. Intracranial Complications
- Underlying contusion / intracerebral hemorrhage
- Extradural hematoma (EDH)
- Subdural hematoma (SDH)
- Subarachnoid hemorrhage (SAH)
- Pneumocephalus (air entry)
4. Soft Tissue Findings
- Scalp swelling / hematoma
- Possible foreign body (in compound fractures)
5. Dural / Brain Involvement
- Dural breach (suggested by pneumocephalus or deep fragment)
- Brain laceration in severe cases
6. Special Situations
- Open (compound) fracture → air, contamination
- Over venous sinus → risk of sinus injury/thrombosis
- Frontal sinus involvement → CSF leak risk
One-line summary:
Inwardly displaced skull fragment(s) on bone window + frequently associated underlying intracranial injury (contusion/hematoma ± pneumocephalus).
