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Open Head Injury

The brain controls all cognitive bodily functions, processes thoughts and emotions, and dictates personality. Damage to the brain can impair any of these functions and, in severe cases, can lead to a vegetative state or death. The skull, which is designed to protect this vital yet fragile organ, is very strong and can withstand incredible force; however, a severe blow to the head may fracture the skull and lead to permanent brain damage.

An open head injury occurs when an object such as a bullet, backed by strong force, fractures the skull and damages brain tissue or the surrounding membranes. Open head injury is a serious form of traumatic brain injury that requires immediate medical attention. Because there is an open wound, open head injury victims may suffer from infection and contamination.

In the United States, the rate of open head injuries has followed the slow decline in gun violence since the 1990s, but it remains a topic for concern. Incidents involving firearms still account for 40 percent of all traumatic brain injury deaths in the U.S. Other common causes of open head injury include motor vehicle accidents, stab wounds and occupational accidents.

Skull Fractures

Open head injuries differ depending on the type of skull fracture, of which there are four:

  • Linear Skull Fracture
  • Depressed Skull Fracture
  • Basilar Fracture
  • Diastatic Fracture

Linear Skull Fracture
Linear skull fracture, or a crack in the skull, accounts for about 69 percent of all open head injuries. Because the injury does not penetrate brain tissue, most linear skull fractures are minor and require little treatment. Nonetheless, it is important to seek immediate medical attention after any traumatic brain injury, including a linear skull fracture.

Depending on the location of the injury, patients with linear skull fractures may suffer a variety of complications, including blood vessel damage and leakage of cerebrospinal fluid from the nose and ears. Cerebrospinal fluid is an important protective element, acting as a cushion to the brain and spinal column; as a result, patients experiencing leakage of this clear liquid are at grave risk of serious injury and brain damage, and are therefore advised to seek immediate medical attention. Cerebrospinal fluid leakage occurs when a linear skull fracture extends into the sinus cavity.

Patients with significant brain swelling may suffer from linear skull fractures as a result of the pressure on the skull.

Depressed Skull Fracture
Depressed skull fractures are often the result of a severe blow to the head with a blunt object. Unlike linear skull fractures, which only break the surface of the skull, broken skull fragments from depressed skull fractures penetrate or compress brain tissue and can cause severe brain damage.

Diastatic & Basilar Skull Fracture
Typically seen in newborns and older infants, diastatic fractures occur when the skull's suture lines (areas where the bones fuse together during childhood) are widened.

In extremely rare instances, victims may sustain breaks at the base of the skull, or basilar skull fractures. Fractures in this area can cause tears in the membranes holding the brain, which may cause leakage of cerebrospinal fluid from the nose and ears.

Open Head Injury Complications

Most open head injuries expose the brain to the outside environment, leaving victims extremely susceptible to infection. It is crucial to seek immediate medical attention after an open head injury to treat the risk of infection. If left untreated, infection can cause permanent brain damage or death.

The most common type of infection resulting from open head injuries is meningitis, or infection of the membranes that surround the brain and spinal column. Caused by bacteria or viruses, meningitis is usually treated with aggressive antibiotics and drugs that reduce brain swelling (corticosteroids).

In addition to meningitis, open head injury can leave the brain vulnerable to other complications, including:

  • Seizures
  • Dementia
  • Paralysis
  • Coma
  • Death

All traumatic brain injury victims also risk suffering from intracranial hematoma, or bleeding in the head or brain.

Open Head Injury Treatment

Open injury treatment depends largely on how badly the skull is fractured and the extent of brain damage. Magnetic resonance imaging (MRI), an intracranial pressure monitor (ICP), or computed tomography (CT) scans can help detect complications and injuries that are not immediately apparent. Because open head injury victims are prone to infection, doctors often administer antibiotics to prevent or treat any infections.

Initial Open Head Injury Treatment
When an open head injury victim arrives at a hospital, doctors quickly assess visible injuries to the head such as external bleeding and skull fracture. Doctors also measure blood pressure, body temperature, heart rate and breathing. The extent of skull and brain damage can be determined with MRI, ICP or CT scans. After identifying and assessing the fracture, doctors then determine whether a patient needs surgery and/or rehabilitation for traumatic brain injury.

Open Head Injury Surgery
In order to repair the fractured skull and stop bleeding in the head, some open head injury victims need surgery. During the operation, a surgeon may remove bone fragments to minimize brain swelling and/or implant synthetic skull pieces to protect fragile brain tissue from further injury.

Postoperatively, patients are monitored for secondary complications, such as intracranial pressure and brain swelling. Patients with high levels of intracranial pressure often need additional surgery to relieve pressure and drain blood that has accumulated beneath the skull. Surgeons drain the blood using a catheter, by drilling holes in the skull or by prescribing strong medications to reduce inflammation.

Open Head Injury Rehabilitation

A crucial component of traumatic brain injury treatment is rehabilitation. Many people need extensive long-term traumatic brain injury rehabilitation to regain important neurological functions, including cognitive thinking skills. This requires the help of several specialists.

  • Physiatrists, rehabilitation physicians who specialize in physical medicine, evaluate open head traumatic brain injury victims and prescribe appropriate rehabilitation plans.
  • Neuropsychologists, or doctors who specialize in brain structure and function, can treat the patient's changes in thinking and behavior following traumatic brain injury.
  • Physical therapists work alongside neuropsychologists to reestablish mobility and simple functions like standing up, walking, brushing one's teeth and using the bathroom.

Rehabilitation programs aim not only to treat brain injury victims but also to help their families cope with the tragedy.

Closed head injury is another type of traumatic brain injury whose complications often differ from those associated with open head injuries. Read more articles on this site to learn about closed head injury and other topics related to traumatic brain injury.

[Last revision: July 2009]

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