MRI is insensitive to fractures and it is often frightening how difficult it is to visualize fractures even when they are prominent and already known about on CT. Underlying cerebral hemorrhagic contusionsĭural tears leading to CSF leak and intracranial hypotension direct caroticocavernous fistula)Įxtension through cranial nerve foramina or canals with neural damage Examples of soft tissue injuries include:Īrterial dissection, occlusion or ruptureĪrteriovenous fistula (e.g. When a fracture is identified, a careful search for adjacent soft tissue injury should be undertaken. Almost invariably, if the fracture involves a paranasal sinus, middle ear or mastoid air cells, then they will contain some blood, which is a helpful clue to the presence of an underlying fracture. They need to be distinguished from normal sutures, which have corticated margins that fractures lack. As this ridge lies above the eyes (orbits) this structure is known as the supraorbital ridge. This ridge along the brow is prominent in males and much smoother in females. Male frontal bones are less rounded and slope backwards at a gentler angle. It is essential that a bone algorithm is used if undisplaced fractures are to be visualized.įractures will appear as discontinuities in the bone and may or may not be displaced. When viewed in profile, female skulls have a rounded forehead (frontal bone). Furthermore, it is obtained at the same time as the brain is imaged.ĬT of the skull should be obtained volumetrically with small (<1 mm) voxels and be able to be reconstructed in multiple planes. Not only is CT sensitive to the detection fractures but it is also able to exquisitely characterize their extent and allow for surgical planning. Skull fractures are best imaged with CT of the brain. They are no longer recommended to assess head injuries unless as part of a skeletal survey for a suspected non-accidental injury of a child 5. Plain radiographs have a limited role and are superseded by CT scans.
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