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Question
23 year-old male fell off porch while intoxicated. The head CT is shown below. Diagnosis?
Answer
Answer: Frontal sinus fracture (inner and outer table) with pneumocephalus.
A few quick pearls when managing skull fractures:
Medical management:
- Little evidence for prophylactic antibiotics; even with a laceration over fracture (i.e., an open fracture)
- Little evidence for prophylactic anti-convulsants
Surgical management, if:
- Skull depression >5mm relative to adjacent segment(s)
- Dural tear; suggested by CSF or pneumocephalus
- Debridement and washout for suspected or confirmed wound contamination
References
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