A skull fracture is a fracture or break in the cranial (skull) bones.
Basilar skull fracture; Depressed skull fracture; Linear skull fracture
Skull fractures may occur with head injuries. The skull provides good protection for the brain. However, a severe impact or blow can cause the skull to break. It may be accompanied by concussion or other injury to the brain.
The brain can be affected directly by damage to the nervous system tissue and bleeding. The brain can also be affected indirectly by blood clots that form under the skull and compress the underlying brain tissue (subdural or epidural hematoma).
A simple fracture is a break in the bone without damage to the skin.
A linear skull fracture is a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone.
A depressed skull fracture is a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brain.
A compound fracture involves a break in, or loss of, skin and splintering of the bone.
Falls, automobile accidents, physical assault, and sports
Bleeding from wound, ears, nose, or around eyes
Bruising behind the ears or under the eyes
Changes in pupils (sizes unequal, not reactive to light)
Difficulties with balance
Drainage of clear or bloody fluid from ears or nose
Loss of consciousness
In some cases, the only symptom may be a bump on the head. A bump or bruise may take up to 24 hours to develop.
If you think someone has a skull fracture:
Check the airways, breathing, and circulation. If necessary, begin rescue breathing and CPR.
Avoid moving the person (unless absolutely necessary) until medical help arrives. Have someone to call 911 (or the local emergency number) for medical assistance.
If the person must be moved, take care to stabilize the head and neck. Place your hands on both sides of the head and under the shoulders. Do not allow the head to bend forward or backward, or to twist or turn.
Carefully check the site of injury, but do not probe in or around the site with a foreign object. It can be hard to know if the skull is fractured or depressed (dented in) at the site of injury.
If there is bleeding, apply firm pressure with a clean cloth over a broad area to control blood loss.
If blood soaks through, do not remove the original cloth. Instead, apply more cloths on top, and continue to apply pressure.
If the person is vomiting, stabilize the head and neck, and carefully turn the victim to the side to prevent choking on vomit.
If the person is conscious and experiencing any of the previously listed symptoms, transport to the nearest emergency medical facility (even if the patient does not think medical help is needed).
Do NOT move the person unless absolutely necessary. Head injuries may be associated with spinal injuries.
Do NOT remove protruding objects.
Do NOT allow the person to continue with physical activities.
Do NOT forget to watch the person closely until medical help arrives.
Do NOT give the person any medicines before talking to a doctor.
Do NOT leave the person alone, even if there are no obvious problems.
When to Contact a Medical Professional
There are problems with breathing or circulation.
Direct pressure does not stop bleeding from the nose, ears, or wound.
There is drainage of clear fluid from the nose or ears.
There is facial swelling, bleeding, or bruising.
There is an object protruding from the skull.
The person is unconscious, is experiencing convulsions, has multiple injuries, appears to be in any distress, or cannot think clearly.
Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.