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Skull fracture vs. accessory sutures: how can we tell the difference?

Sanchez T, Stewart D, Walvick M, Swischuk L - Emerg Radiol (2010)

View Article: PubMed Central - PubMed

Affiliation: University of California Davis, Sacramento, CA, USA. thomas.sanchez@ucdmc.ucdavis.edu

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Plain film radiography remains the most cost effective method in evaluating skull fractures and can easily differentiate major sutures and common vascular grooves from fractures... Therefore if cranial CT is deemed clinically necessary in trauma patients, questionable fractures can be confidently differentiated from unusual accessory sutures using these additional workstation capabilities... One study has shown that at least 4 mm of soft tissue swelling was present on the cranial CT scan in all cases of acute skull fractures that they reviewed... However, absence of subgaleal hematoma or swelling does not entirely rule out a fracture especially if the injury is remote or imaging was performed several days after the trauma... CT scan with 3D reconstruction was performed and showed a well-defined lucency extending into the lambdoid suture... There is no associated diastasis or widening and it does not extend into the foramen magnum posteriorly... A fracture usually will show evidence of healing or sclerosis in two or three months... In summary, fractures and accessory sutures can be differentiated in most cases by observing its characteristics such as bilaterality, symmetry, associated diastasis, and presence of soft tissue swelling (Table 1)... Knowledge of the normal anatomy, development, and timing of sutural closure are also necessary to decipher the varied and sometimes complex nature of these accessory sutures especially in the occipital region... However, in difficult cases, it is prudent to request for a follow-up study to look for signs of healing.

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This midline occipital fracture extending into the foramen magnum is easily differentiated from a normal persistent midline occipital fissure because of its length, extending 3 cm from the dorsal lip of the foramen magnum
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Fig7: This midline occipital fracture extending into the foramen magnum is easily differentiated from a normal persistent midline occipital fissure because of its length, extending 3 cm from the dorsal lip of the foramen magnum

Mentions: Knowledge of the normal anatomy, development and timing of sutural closure are also important in the evaluation of questionable fractures. The occipital and innominate sutures are no longer apparent by age 4 while the mendosal suture completely fuses by 6 years of age [10]. An example of an accessory suture that can be misleading is the normal persistent occipital suture. It extends from the dorsal aspect of the foramen magnum and can appear wide and sharp. However, it should extend no more than 2 cm from the edge of the foramen magnum. A longer fissure would be inconsistent with its normal embryogenesis and therefore represents a fracture [3] (Fig. 7). In some cases where a lucency is shorter than 2 cm, the age of the patient would help in deciding if this is a fracture or just a sutural remnant. As noted previously, this suture closes by 4 years and a persistent lucency beyond this age is indicative of a fracture.Fig. 7


Skull fracture vs. accessory sutures: how can we tell the difference?

Sanchez T, Stewart D, Walvick M, Swischuk L - Emerg Radiol (2010)

This midline occipital fracture extending into the foramen magnum is easily differentiated from a normal persistent midline occipital fissure because of its length, extending 3 cm from the dorsal lip of the foramen magnum
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2914264&req=5

Fig7: This midline occipital fracture extending into the foramen magnum is easily differentiated from a normal persistent midline occipital fissure because of its length, extending 3 cm from the dorsal lip of the foramen magnum
Mentions: Knowledge of the normal anatomy, development and timing of sutural closure are also important in the evaluation of questionable fractures. The occipital and innominate sutures are no longer apparent by age 4 while the mendosal suture completely fuses by 6 years of age [10]. An example of an accessory suture that can be misleading is the normal persistent occipital suture. It extends from the dorsal aspect of the foramen magnum and can appear wide and sharp. However, it should extend no more than 2 cm from the edge of the foramen magnum. A longer fissure would be inconsistent with its normal embryogenesis and therefore represents a fracture [3] (Fig. 7). In some cases where a lucency is shorter than 2 cm, the age of the patient would help in deciding if this is a fracture or just a sutural remnant. As noted previously, this suture closes by 4 years and a persistent lucency beyond this age is indicative of a fracture.Fig. 7

View Article: PubMed Central - PubMed

Affiliation: University of California Davis, Sacramento, CA, USA. thomas.sanchez@ucdmc.ucdavis.edu

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Plain film radiography remains the most cost effective method in evaluating skull fractures and can easily differentiate major sutures and common vascular grooves from fractures... Therefore if cranial CT is deemed clinically necessary in trauma patients, questionable fractures can be confidently differentiated from unusual accessory sutures using these additional workstation capabilities... One study has shown that at least 4 mm of soft tissue swelling was present on the cranial CT scan in all cases of acute skull fractures that they reviewed... However, absence of subgaleal hematoma or swelling does not entirely rule out a fracture especially if the injury is remote or imaging was performed several days after the trauma... CT scan with 3D reconstruction was performed and showed a well-defined lucency extending into the lambdoid suture... There is no associated diastasis or widening and it does not extend into the foramen magnum posteriorly... A fracture usually will show evidence of healing or sclerosis in two or three months... In summary, fractures and accessory sutures can be differentiated in most cases by observing its characteristics such as bilaterality, symmetry, associated diastasis, and presence of soft tissue swelling (Table 1)... Knowledge of the normal anatomy, development, and timing of sutural closure are also necessary to decipher the varied and sometimes complex nature of these accessory sutures especially in the occipital region... However, in difficult cases, it is prudent to request for a follow-up study to look for signs of healing.

Show MeSH
Related in: MedlinePlus