UMEM Educational Pearls


23 year-old male fell off porch while intoxicated. The head CT is shown below. Diagnosis?


Answer: Frontal sinus fracture (inner and outer table) with pneumocephalus.

A few quick pearls when managing skull fractures:

Medical management:

  • Little evidence for prophylactic antibiotics; even with a laceration over fracture (i.e., an open fracture)
  • Little evidence for prophylactic anti-convulsants

Surgical management, if:

  • Skull depression >5mm relative to adjacent segment(s)
  • Dural tear; suggested by CSF or pneumocephalus
  • Debridement and washout for suspected or confirmed wound contamination


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