Open Head Injury

The brain is the most important organ in the human body. The brain not only controls all bodily functions; it also processes thoughts, emotions, and personality. To protect this vital yet fragile organ, the skull can withstand some incredible forces. However, a person's skull can fracture to an extent that it fails to protect the brain. Ironically, in some cases, the skull may actually cause injury to the brain.

Traumatic brain injury from a fractured or penetrated skull is an open head injury. Open head injury occurs when a strong force breaks the skull or when an object, like a bullet, penetrates skull bone and brain tissue. Although not all traumatic brain injuries fracture the skull, skull fracture is a serious condition. Skull fracture also invites infection and contamination to the open wound and to the brain.

During the past 20 years, doctors have seen a dramatic increase in open head injuries and penetrating injuries to the brain. In many cities throughout the United States, gunshot wounds to the head have become a primary cause of open head injury. Unintentional or intentional violence or trauma such as stab wounds, motor vehicle accidents, or occupational accidents can cause open head injury. Any of these events can puncture or penetrate the skull, causing skull fracture.

Skull Fractures

There are many ways in which the skull may become fractured, and there are many types of skull fractures. The two most common types of skull fractures are linear and depressed skull fractures. Basilar fracture and diastatic fracture are other skull fracture types.

Linear Skull Fracture

Linear skull fracture refers to a crack or break in the skull. Linear skull fracture is common, occurring in about 62 percent of people with traumatic brain injury. Occasionally, a linear skull fracture is minor and requires little treatment, as fractured skull bone does not penetrate brain tissue. But a doctor will still detect and treat any potential brain injury or damage.

The location of a skull fracture is very important. Linear skull fracture can cause cerebrospinal fluid leakage through the ears or nose if the fracture extends into the sinus cavity. Linear skull fracture near the base of the skull can cause nerve or blood vessel damage. If injury-induced swelling within the skull produces significant pressure, the pressure can push the joints between the skull bones (cranial sutures) and result in linear skull fracture.

Depressed Skull Fracture

Depressed skull fracture occurs when broken skull fragments penetrate brain tissue or press down on top of the brain. Traumatic brain injury victims often sustain depressed skull fracture if struck in the head with a blunt object. Broken bone from depressed skull fracture can penetrate the delicate brain tissue, and as a result, precious brain tissue is destroyed.

Diastatic & Basilar Skull Fracture

Diastatic fractures occur along the skull's suture lines, which are areas between the bones in the head. During childhood, these bones fuse together. In this type of fracture, the normal suture lines are widened. These fractures are most commonly seen in newborns and older infants.

Although rare, basilar skull fractures are very serious. Basilar skull fracture is a break at the base of the skull. If the fracture extends into the nasal sinus cavity, individuals with basilar skull fracture can have clear fluid draining from their nose and ears (cerebrospinal fluid). Cerebrospinal fluid is fluid that cushions the brain and spinal column. If cerebrospinal fluid seeps from a person's ears or nose, this is a sign of serious skull fracture.

Open Head Injury Complications

In the case of open head injury, the brain is extremely susceptible to infection, because the skull is fractured and no longer protects brain tissue from the environment. Meningitis is a common open head injury infection. Meningitis is an infection of the membranes that surround the brain and spinal column (meninges). The infection can be caused by bacteria or viruses. Doctors treat meningitis with aggressive antibiotics and drugs that reduce brain swelling (corticosteroids), but the infection is fatal if untreated. Exposed brain tissue is especially vulnerable. If bone or other object fragments penetrate the brain, brain damage from infection is profound.

An open head injury can lead to other very severe complications like seizures, dementia, paralysis, coma, and death. Hematoma, or bleeding in the head or brain, is an exceptionally troubling complication of both open head injury and closed head injury.

Open Head Injury Treatment

Open head traumatic brain injury treatment depends largely on how badly the skull is fractured and how badly the brain is damaged. Magnetic resonance imaging (MRI), an intracranial pressure monitor (ICP), or computed tomography (CT) scans can help detect any unapparent complications and injuries. Because open head traumatic brain 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 injury 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.

Open Head Injury Surgery

To repair the fractured skull and to stop bleeding in the head, surgery is most often necessary. To improve blood and oxygen flow to the brain, a trauma surgeon, neurosurgeon, or general surgeon works to minimize any brain swelling. To protect fragile brain tissue from further injury, bone fragments are removed or replaced with synthetic skull pieces.

Following surgery, patients are monitored for secondary complications such as intracranial pressure and brain swelling. To relieve pressure and drain blood collection, surgeons will operate if intracranial pressure threatens further brain damage. To help decrease intracranial pressure by draining blood or cerebrospinal fluid from the skull, a surgeon may insert a catheter into the skull. A surgeon may drill holes into a person's skull (craniotomy) to relieve pressure. Very strong medications such as corticosteroids may also be given to help reduce brain inflammation and swelling.

Open Head Injury Rehabilitation

A crucial component of traumatic brain injury treatment is rehabilitation. Many people need extensive and expensive long-term traumatic brain injury rehabilitation to regain important neurological functions.

A physiatrist, a physician that specializes in physical medicine and rehabilitation, evaluates an open head traumatic brain injury victim and prescribes appropriate rehabilitation. A neuropsychologist, a doctor who specializes in brain behavior, treats a person's changes in thinking and behavior following brain injury. A physical therapist works alongside the neuropsychologist to re-establish mobility and simple functions like standing up or walking, brushing one's teeth, and using the bathroom.

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

Closed head injury is another type of traumatic brain injury. Read more to learn about closed head injury and other topics related to traumatic brain injury.

[Last revision: March 2007]