Surgical management of depressed cranial fractures

The majority of studies are case series. No controlled, prospective clinical trials of treatment using surgical versus nonsurgical management have been published. The majority of data support debridement and elevation of grossly contaminated compound depressed cranial fractures as soon as possible after injury. However, several retrospective studies demonstrate successful non-operative management of some patients with less-severe compound depressed cranial fractures on the basis of CT and clinical criteria. In the absence of gross wound infection at the time of presentation, immediate replacement of bone fragments seems not to increase the incidence of infection if surgery is performed expeditiously, and this replacement eliminates the need for subsequent cranioplasty and its attendant risks and complications. No controlled data exist to support the timing of surgery or the use of one technique over another.