• Sanjeev Kumar, Shashank Nahar, Debabrata Sahana, Amit Kumar Jain, Lavlesh Rathore, Naman Chandrakar, Ghanshyam Sasapardhi, Manish Tawari, Jatinder Mittal, and Rajiv Kumar Sahu.
• Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India. Electronic address: ksanjeev79@gmail.com.
• World Neurosurg. 2022 Aug 1; 164: e1281-e1289.

ObjectiveThe Brain Trauma Foundation issued level III evidence guidelines for surgical management of compound depressed fractures. However, some patients undergo successful conservative treatment. This study compares these 2 treatment modalities.MethodsThis prospective study included 67 patients with compound depressed skull fractures with surgical indications and a minimum follow-up of 6 months. Depressed fractures in front of the hairline (operated on for cosmetic reasons) and associated with significant intracranial injuries were excluded. Those who gave consent for surgery were included in the surgical group, and those who denied were included in the conservative group.ResultsThe surgical group had 38 patients and the conservative group had 29. Both groups were comparable in mean age, gender, Glasgow Coma Scale score, head injury severity, depth of fractures, and follow-up duration. Focal neurologic deficits were observed in 19 patients at presentation and were higher in the surgical group. Mean hospital stay was significantly shorter in the conservative group. Mean Glasgow Outcome Scale score at follow-up was statistically similar in both groups (P = 0.13). Focal neurologic deficits improved equally in both groups (P = 0.67). The severity of traumatic brain injury (P = 0.004) and the presence of focal neurologic deficits (P < 0.001) affected the neurologic outcomes. The age, gender, mode of treatment (surgery vs. conservative), surgical site infections, and seizures did not affect neurologic outcomes. The overall complication rates were similar among groups (P = 0.50). New-onset focal neurologic deficits, seizures, and infection rates were not significantly different among the groups (P = 0.98, P = 0.72, P = 0.69).ConclusionsConservative management has equivalent neurologic outcomes and complications compared with surgical management.Copyright © 2022 Elsevier Inc. All rights reserved.

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