THE EFFECTIVENESS OF SURGICAL TREATMENT OF DEPRESSED SKULL FRACTURES IN INFANTS

Mamatkulov Alisher D., Zaitseva Ekaterina S., Semenova Zhanna B., Akhadov Tolibjon A.

Introduction: The incidence of depressed skull fractures in infants ranges from 2 to 20%. One of the specific features of depressed fractures in infants is an unusual depression shape (resembling a ping-pong ball) which requires specific approaches to their surgical correction. Purpose: To assess the effectiveness of two surgical techniques for treating infants with depressed ping-pong ball-like fractures of the skull. Material and methods 2 400 children under one year of age with traumatic brain injury were hospitalized to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, in Moscow from 2017 to 2021. 1 108 of them had computed tomography scanning, and in 27 of them a depressed “ping-pong ball” type fracture of the skull was diagnosed. There were no signs of intracranial pathology. The authors have made a retrospective analysis of outcomes in infants after the reposition of their depressed “ping-pong ball” type skull fractures with a reduction microscrew and/or an elevator. 20 patients had percutaneous reposition of the depressed fracture with a reduction microscrew, and 7 patients - with an elevator. All infants (n-27) were operated on within the first 24 hours after admission. Results. Surgical intervention with a reduction screw lasted for 10 ± 1.3 minutes, and with an elevator - 25 ± 2.3 minutes. There were no complications in the postoperative period. Patients stayed in the hospital for one day after screw application , and for two days – after elevator application. Conclusion. Both reposition techniques are highly effective for the surgical treatment of depressed skull fractures in infants. They quickly correct the pathology, minimize the risk of clinical manifestations, and promote optimal aesthetic outcomes. A comparative assessment of surgery duration, postoperative course, complications, and costs of hospital stay has shown that reposition with a reduction screw is faster and less traumatic, but if there is no effect, it can be converted to the reposition with an elevator.

Keywords:traumatic brain injury, depressed skull fracture, reduction microscrew, elevator, pediatric neurosurgery