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Skull fracture (depressed, compound)

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The aim of treating a depressed, compound skull fracture is to prevent infection by:

wound debridement - remove hair, necrotic scalp, dirt

elevation of bone fragments and removal of necrotic brain if necessary

prophylactic broad spectrum antibiotics should not be given

prophylactic anticonvulsants - e.g. phenytoin

Ideally, all steps are to be done within 6 hours or at most, 12 hours.

A dural substitute - e.g. fascia lata from the thigh - may be necessary if part of the dura has been lost. This stops the dura from sticking to the skin and reduces the risk of tearing blood vessels if later cranioplasty needs to be done.

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Treatment

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