DEPRESSED SKULL FRACTURES (A RETROSPECTIVE ANALYSIS OF 162 CASES ACCORDING TO PAEDIATRIC AND ADULT GROUPS)

1255 patients with head trauma were hospitalized in our clinic between January 1990 and June 1995. Only 162 cases who had depressed skull fractures were accepted for this study. 75 (46.2%) of them were in paediatric age (0-16) and 87 (53.8%) patients were in adult group (17 and above). The most frequent aetiological factors were falling in paediatric group and motor accidents in adults. The neurological state of the patients were assessed by Glasgow Coma Scale (GCS). The most common location of depressed fracture of the skull was at parietal bone in both groups while closed fractures in paediatric age and open type depressed fractures in adult group were seen frequently The most accompaniment pathology of depressed skull fractures was cerebral contusion in both groups. 129 patients (80%) were managed surgically while 33 of them (20%) were treated by conservative procedures. In open depressed fractures, we observed dura and/or brain laceration in 54% of paediatric age and 71% of adult group. As complications, posttraumatic epilepsy was observed 8% in children, 10.3% in adult group and rate of infection was 4% in children, 9% in adults. According to Glaskow Outcome Scale (GOS), good recovery was seen in 84% of paediatric age and 60% of adult group, mortality rates of paediatric and adult groups were 4% and 17% respectively.

ÇÖKME KIRIKLARI (162 OLGUNUN RETROSPEKTÝF OLARAK ÇOCUK VE ERÝÞKÝN YAÞ GRUPLARINA GÖRE DEÐERLENDÝRÝLMESÝ)

Kliniðimizde Ocak 1990-Haziran 1995 yýllarý arasýnda 1255 kafa travmalý hasta yatýrýlarak tedavi edilmiþtir. Bu hastalardan 162'sinde (%12.5) çökme kýrýðý saptanarak bu çalýþmaya dahil edilmiþtir. 162 hastanýn 75'ini (%46.2) çocuk (0-16 yas), 87 (%53.8) tanesini eriþkin (17yaþ ve üzeri) yaþ grubu oluþturmuþtur. Biyolojide, çocuklarda düþme, eriþkinlerde ise trafik kazalarý ilk sýrayý almýþtýr. Hastalarýn klinik tablosu Glasgow Koma Skalasýna (GKS) göre deðerlendirilmiþtir. Çökme kýrýðý, her iki yaþ grubunda da en fazla parietal bölgede saptanmýþtýr. Çocuklarda kapalý, eriþkinlerde ise açýk çökme kýrýklarý daha fazla görülmüþtür. Her iki yaþ grubunda da çökme kýrýðý ile birlikte en fazla görülen patoloji kontüzyondur. Hastalarýn 129'una (%80) cerrahi, 33 'üne (%20) konservatif tedavi yapýlmýþtýr. Açýk çökme kýrýklarýnda dura ve/veya beyin laserasyonu çocuklarda %59, eriþkinlerde ise %71 oranýnda bulunmuþtur. Komplikasyon olarak posttravmatik erken epilepsi, çocuklarda %8, eriþkinlerde ise 10.3 oranýnda, enfeksiyon ise çocuklarda %4, eriþkinlerde ise %9 oranýnda tespit edilmiþtir. Sonuçlar Glasgow Sonuç Skalasýna (GSS) göre deðerlendirilmiþtir. Tam iyileþme çocuklarda %84, eriþkinlerde %60 oranýnda olurken, mortalite oraný ise eriþkinlerde %17, çocuklarda %4 olarak bulunmuþtur.