What does it mean when your doctor tells you that you have got a skull fracture.
Your main concerns often arise about treatment and recovery, whether you will be able to resume your normal activities like before the fracture.
As a diagnostic radiographer, I’m addressing your most frequently asked questions about skull fracture recovery and treatment steps usually taken.
⚫I rely on my knowledge as a radiographer who has seen first-hand skull fracture injuries.
⚫And scientific publications on the subject matter, all references at the end of this article.
If you have any questions or remarks type at the end of this article in the comments section. Happy reading!😀
Last updated: Feb 2025. Written by Juliet Semakula, a diagnostic radiographer
Disclaimer: no affiliate links.
▶️First let’s clearly distinguish between
1️⃣A head skull fracture.
2️⃣A traumatic brain injury.
A head skull fracture
A head injury is a broad term that describes a vast array of injuries that occur to the scalp, skull, brain, and underlying tissue and blood vessels in the head,
So, when you have got a fracture on your head this means your skull has got a break, it could be traumatic or not.
A skull fracture is a type of head injury where the skull bone breaks, it could be mild or severe, well as a brain injury may occur without a fracture
A traumatic brain injury.
This means there have been various types of injury to your head.it means there has been an impact, blow or force applied to the head.
You can have a traumatic brain injury without a skull fracture. However, you cannot have a skull fracture without a traumatic brain injury.
As a diagnostic radiographer I have seen a few skull fractures over the years of my experience.
And for this article I will focus on skull fractures injury and not traumatic brain injuries in general.
▶️What are different types of skull fracture
Skull fractures can be experienced by both children and adults caused by minor or severe head trauma.
Fracture patterns and associated complications depend on the location of the injury, which is often determined by the mechanism of injury and type of impact.
Here are some of the common types:
🟧Linear skull fractures. This is the most common type of skull fracture I see in x-ray; it occurs in a straight line without significant displacement of bone fragments.
🟧Depressed skull fractures. This type of fracture may be seen with or without a cut in the scalp.it involve a depression of the skull
🟧Basilar skull fracture affects the base of the skull near the back, these are normally nondisplaced fractures, but they can be associated with critical complications (Baugnon,2014)
🟧Open fracture to the skull, this can carry a high risk of infection, this kind of fracture creates a communication between the outside of the skull and the cranial cavity.
🟧Diastatic fractures occur when cranial sutures are separated, most commonly with the lambdoid suture.
🟧Growing skull fracture is not common, this is the herniation of the brain through the broken dura following a skull fracture.
McGrath,2023
X-ray image of a linear right parietal skull fracture image retrieved from (Ciurea et al 2011)
▶️What are the symptoms or red flags of a skull fracture
When you have had a skull fracture you will experience certain symptoms, these could be different for each person.
🔴Pain in the injured area.
🔴Swelling in the injured area
🔴Obvious depression or abnormality in the injured area
🔴Warmth, bruising, or redness in the injured area
🔴Blood or clear fluid draining from the ears or nose
🔴Bruising behind the ears or around the eyes
🔴Facial weakness
▶️How serious is a fractured skull? What are the consequences?
It doesn’t matter whether you think your head injury is minor or severe:
A skull fracture whether a mild break or not can cause few problems that may require urgent care.
So, the only way for you to know if your injury is serious is for you to get it checked.
Your doctor will look for any complications by doing different tests to assess any signs of bleeding, brain damage, leaking of cerebrospinal fluid, infection and seizures.
The consequences of a skull fracture can vary depending on the severity of the fracture, location and any associated injuries to the brain.
If your skull fracture is relatively gentle (minor) you may have temporary symptoms such as:
🔴Pain and headache.
🔴Bruising.
🔴Swelling.
If your skull fracture is severe, in this case you may have these complications:
🔴Brain damage
🔴Infection
🔴Post -concussion syndrome
🔴Developing seizures especially in the first year after the injury.
🔴Long term complications such as chronic headaches, hearing loss or vision problems. But this is rare.
▶️What is the difference between adult and children skull fractures?
Adults and children can sustain skull fractures, but there are important differences between the bones of children compared with those of adults.
️1️⃣Paediatric (children) brains and craniofacial head skeleton are in their remodelling stages because they are still growing
2️⃣so, any head trauma causing fractures has a greater capacity to remodel and this reduces the risk of fractures to children.
3️⃣Bones in children are more tender and softer than adults.so with a skull fracture there is a higher chance of healing then an adult fracture.
4️⃣Children with minor blunt head trauma and isolated linear skull fractures are at very low risk of evolving other traumatic findings noted in subsequent imaging studies or requiring neurosurgical intervention.
▶️How are skull fractures diagnosed?
Normally after your doctor has examined you, he will request a few scans to confirm the diagnosis.
🟤X-ray imaging
Working in x-ray I have refused to x-ray patients with skull fractures:
Reason being plain X-ray is usually not a good type of scan to evaluate skull fractures.
According to most hospital protocols and scientific studies, x-ray usually provide false- negative results (Powell ,2015)
X-ray cannot absorb the double layered skull along the fracture whose cross section shows oblique to the direction of the x-ray.
🟤Computed Tomography (CT) or MRI scan
So, CT or MRI should always be the first line of scan because it is a gold standard for the evaluation of head injuries.
🟤Ultrasound can be used to identify skull fractures in younger patients, although it is not widely used, further studies are needed to assess its efficacy.
For example, a study done on 278 patients with mild head linear injuries who had undergone x-ray imaging, the results come out negative yet when they were sent for a CT scan, linear fracture was seen (Nakahara, 2011)
X-ray images and CT scan of a 19-month-old boy. (A) No obvious linear fracture is seen on anteroposterior and lateral skull radiographs. (B) Bone window CT scan showing a fracture line oblique to the direction of the x-rays used in the lateral view (arrow). (Nakahara, 2011)
So imaging and other tests will be done to fully diagnose a skull fracture, it will all be written in your medical report.
▶️ What to do urgently if someone has a skull fracture?
I will highlight 7 points that I was touched at University and what I have seen in practice.
These steps may help you while waiting for emergency medical help to arrive:
1️⃣Check the airways, breathing, and circulation. If necessary, begin rescue breathing and CPR if needed.
2️⃣Keep the person still lying down with the head and shoulders slightly elevated and immobilised. Have someone call an emergency.
3️⃣If 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.
4️⃣Then if there is any bleeding you can stop the bleeding by applying firm pressure to the wound with sterile gauze or a clean cloth.
5️⃣Avoid applying pressure directly onto a suspected skull fracture.
6️⃣If the person is vomiting, stabilize the head and neck, and carefully turn the victim to the side to prevent choking on vomit.
7️⃣Watch if there are any changes in breathing and alertness of the patient, keep them at rest and encourage them to stay calm.
▶️Things to avoid as you wait for help to arrive.
🔴Do not move the person unless you have detected danger because head injuries may be associated with spinal.
🔴Do not forget to watch the person or leave him alone until help arrives
🔴Do not give the person any medicines before talking to a healthcare provider.
🔴Do not remove protruding objects.
▶️What are the treatment options for a fractured skull?
Treatment and management of skull fractures will depend on a few things:
♦️Location and type of fracture you have got.
♦️If there is a presence (or absence) of underlying brain injury.
♦️Your medical health history
♦️Your age
▶️Types of management:
conservative options.
Once the diagnosis of a skull fracture is made, at a minimum, medical monitoring will be put in place, this could be for days, weeks, months or even years depending on the type of injury.
Most skull fractures I have seen which a minor Linear without underlying brain injury require no intervention.
Most skull fractures will heal by medication and monitoring, particularly if they’re simple, linear fractures.
The healing process can take days, weeks or many months. Some people complain of headaches for a few weeks.
I have seen younger and symptomatic patients with skull fractures admitted in the hospital for observation.
Different hospitals have their own practice on how they manage skull fractures. Some recommend for observation periods or close outpatient follow-up.
In some cases. Surgery may be necessary:
The fracture may be reduced and realigned using Plates, screws or other fixation devices
For example:
♦️Basal skull fractures are usually managed conservatively unless there is persistent (CSF cerebrospinal fluid) leakage.
Which occur when the protective fluid surrounding the brain and spinal cord escapes through a hole or tear in the dura mater, the outermost layer of the meninges (Mohamad 2021)
In some cases, a temporary drain may be placed to remove excess fluid or surgical closure of leaks or defects at the skull base is done to prevent further complications (Abuabara, 2007)
CSF drainage procedures must be decided with great care and with a clear strategy.
♦️Frontal bone skull fractures are more likely to require neurosurgical repair.
♦️A depressed skull fracture of 5 millimetres or more usually may require intervention.
These kinds of fractures may have an underlying hematoma (this is a collection of blood that pools outside of the blood vessels) or a gross contamination
♦️An open skull fracture may require exploration to remove bone fragments and washout with antibiotic coverage
McGrath,2023
Usually, your doctor will tell you what kind of treatment you need for the type of fracture you have had.
However, experience has shown that each fracture category merits its own management strategies.
Accepted approaches are based on observation only. There is little to no scientific evidence to support treatment for any fracture type
▶️Recovering from a skull fracture: what to expect.
The recovery timeline for a skull fracture varies depending on the severity of the injury and any other associated complications
Here are some of the proposed healing timelines divided into stages if your skull fracture had no other associated injuries.
Stage 1️⃣: Acute phase (0 to 2 weeks) your body will begin the healing process. Skull fractures have a good capacity to consolidate faster than other bones in the body.
Reason being the head has many blood vessels which promotes blood circulation and supply of nutrients for healing.
However, I have had some patients complain of headache, fatigue and nausea during this phase
It is very crucial at this stage to follow your doctors’ instructions regarding pain and activity restrictions.
Stage 2️⃣: (2 to 6 weeks): your fracture is beginning to consolidate, keep following your doctor’s instructions and get enough rest and avoid anything that may lead to further head injury.
Stage 3️⃣:( 6 to 8 weeks and more): at this stage your fracture may have healed completely in some people
The maximum healing needed is 7 and half months and 22 days of minimum observation.
However, some patients may continue to experience symptoms such as headaches or cognitive difficulties for several months after the injury.
▶️We need to agree on what we mean by healing time
🟪The time for the bone to consolidate we have discussed above.
🟪The healing time for associated injuries such as nerves, other fractures and brain injuries.
🟪Or the time needed for you to resume your normal activities before the injury.
Caution! It is very important to understand that the recovery timeline may vary depending on individual circumstances and the presences of any other complications.
Some people will take only a few days or weeks to fully regain their life like before the injury; others may take months and years.
The truth is making a precise prognosis is almost impossible but doctors, surgeons and physiotherapists who are looking after you can discuss this with you for a better personalised answer to this question.
▶️Do you need rehabilitation after a skull fracture?
Here at the hospital where I work, I have seen patients with skull fractures go through different steps of rehabilitation, but this still depends on individual needs.
⚫Physical therapy may be necessary to help you regain strength, balance and coordination if you lost them after the injury.
⚫Cognitive therapy if you lost your memory after the injury, this therapy would help improve memory and attention skills.
⚫Pain management with medication can help with the headaches.
⚫Lifestyle modifications such as contact sports if it was the cause of your injury.
⚫Regular follow up appointments to monitor the healing process and address any concerns of complications you may have.
We have come to the end of this article, any experiences type and share in the comments sections.
Wishing you a quick recovery.!🙋
📚Source:
Nakahara K, Shimizu S, Utsuki S, Oka H, Kitahara T, Kan S, Fujii K. Linear fractures occult on skull radiographs: a pitfall at radiological screening for mild head injury. J Trauma. 2011 Jan;70(1):180-2. doi: 10.1097/TA.0b013e3181d76737. PMID: 20495486.
Powell EC, Atabaki SM, Wootton-Gorges S, Wisner D, Mahajan P, Glass T, Miskin M, Stanley RM, Jacobs E, Dayan PS, Holmes JF, Kuppermann N. Isolated linear skull fractures in children with blunt head trauma. Pediatrics. 2015 Apr;135(4):e851-7. doi: 10.1542/peds.2014-2858. Epub 2015 Mar 16. PMID: 25780067.
Baugnon KL, Hudgins PA. Skull base fractures and their complications. Neuroimaging Clin N Am. 2014 Aug;24(3):439-65, vii-viii. doi: 10.1016/j.nic.2014.03.001. Epub 2014 May 24. PMID: 25086806.
McGrath A, Taylor RS. Pediatric Skull Fractures. [Updated 2023 Jan 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan:
Mohamad J. Schädelbasisfrakturen [Basilar skull fractures]. Radiologe. 2021 Aug;61(8):704-709. German. doi: 10.1007/s00117-021-00879-3. Epub 2021 Jul 8. PMID: 34236447.
Abuabara A. Cerebrospinal fluid rhinorrhoea: diagnosis and management. Med Oral Patol Oral Cir Bucal. 2007 Sep 1;12(5):E397-400. PMID: 17767107.
Image from Research gate: Traumatic brain injury in infants and toddlers,0-3 years old
Ciurea, Alexandru & Gorgan, M & Tascu, Alexandru & Sandu, Aurelia & Rizea, Radu. (2011). Traumatic brain injury in infants and toddlers, 0–3 years old. Journal of medicine and life. 4. 234-43.