![]() ![]() **** Fracture or suture ? Have a look at the images below and decide what you would call them. Always ensure proper alignment and reconstruction before assessment (which will aid greatly in assessing for things like symmetry).Although one does not necessarily need to have a fracture to have intracranial injuries (especially in the paediatric population). Fractures normally come with other ancillary signs, such as extracranial haematoma, cortical incongruity, intracranial haemorrhage, contusions, or contra-coup injuries. ![]() It is good at providing an overview, course, linearity, symmetry and separation, which are helpful features in distinguishing fractures from sutures. Although not to be used in isolation, 3D VR is helpful in problem solving and visualising complex fractures.The fracture is identified due to the projection of dense bone over the skull. Understand the normal closure patterns and evolution of the developmental sutures. CSF leak Radiographic features Plain radiograph Rarely undertaken, especially outside of the pediatric population.Extracranially, there is a large left subgaleal haematoma (red arrow head). The parietal bone ossifies from two centers while the occipital bone ossifies from six centers 2, 3.An accessory intraparietal or subsagittal suture is rare but can be seen dividing the parietal bone (Fig. 12: Axial CT image of the same child, demonstrating a left frontal extradural haematoma (white arrow) and also a shallow left subdural haematoma (white arrow head). The parietal and occipital bones in particular are common regions for accessory sutures because of their multiple ossification centers. Image d: Further assessment with 3D volume rendering (VR) demonstrates the fractures on the right and can be clearly seen as a fracture crossing the right coronal suture (black arrow heads) and involves both the right frontal and parietal bones. The known left parietal fracture (white arrow) can also be easily visualised here on the 3D VR.įig. The middle cranial fossa is the weakest, with thin bones and multiple foramina. They appear comminuted with depressed fragments. The skull is prone to fracture at certain anatomic sites that include the thin squamous temporal and parietal bones over the temples and the sphenoid sinus, the foramen magnum, the petrous temporal ridge, and the inner parts of the sphenoid wings at the skull base. Image c: More fractures (white arrow heads) are seen on the right frontal bone as we approach the vertex. Image b: Axial section more superiorly demonstrates widening of the fracture (white arrow) as it approaches the left coronal suture (blue arrow head). ![]() Note also the soft tissue haematoma (red arrow head) adjacent to the fracture. Image a: Note the difference between the sharp lucency in keeping with a left parietal bone fracture (white arrow) vs the sclerotic zig-zag pattern of a normal lambdoid suture (Purple arrow head). 10: Axial and 3D volume rendered CT images of a 1.5 years old child who sustained a major trauma, resulting in multiple skull fractures bilaterally. ![]()
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