• M Ross Bullock, Randall Chesnut, Jamshid Ghajar, David Gordon, Roger Hartl, David W Newell, Franco Servadei, Beverly C Walters, Jack Wilberger, and Surgical Management of Traumatic Brain Injury Author Group.
• Department of Neurological Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
• Neurosurgery. 2006 Mar 1; 58 (3 Suppl): S56-60; discussion Si-iv.

IndicationsPatients with open (compound) cranial fractures depressed greater than the thickness of the cranium should undergo operative intervention to prevent infection. Patients with open (compound) depressed cranial fractures may be treated nonoperatively if there is no clinical or radiographic evidence of dural penetration, significant intracranial hematoma, depression greater than 1 cm, frontal sinus involvement, gross cosmetic deformity, wound infection, pneumocephalus, or gross wound contamination. Nonoperative management of closed (simple) depressed cranial fractures is a treatment option.TimingEarly operation is recommended to reduce the incidence of infection.MethodsElevation and debridement is recommended as the surgical method of choice. Primary bone fragment replacement is a surgical option in the absence of wound infection at the time of surgery. All management strategies for open (compound) depressed fractures should include antibiotics.

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