Surgical management and outcome of depressed skull fractures at Niamey National Hospital: About 233 cases

Background

Depressed skull fractures constitute a common trauma condition in neurosurgery. Their surgical aspects and outcome remain less studied at Niamey.

Objective

To study the surgical aspects and describe the outcome of surgical depressed skull fractures at Niamey National Hospital in Niger republic.

Method

This is a three years retro and prospective study from January 1st, 2020 to December 31st, 2022 run at National Hospital of Niamey in Niger republic.

Results

A total of 233 patients were included of which, 202 men (86.7 %) and 31 females (13,3%) with a sex-ratio of 6.51. Road traffic accident was the common cause (n = 141; 60.5 %) followed by assault (n = 43; 18.5 %) and fall (n = 27; 11.6 %). Patients from urban area were predominant (n = 161; 69.1 %). Head CT Scan constituted the most common diagnosis tool. Considering the type of depressed fractures, greenstick depressed fractures were the most frequent (n = 139; 59.7 %) followed by comminuted ones (n = 70; 30 %). Ping-pond fractures accounted for 24 cases (10.3 %) and were only seen in children. About the type of associated injury, cranio-cerebral wound (n = 73; 31,3%), extradural hematoma (n = 31; 13.3 %), and cerebral contusion (n = 10; 4.3 %) were commonly seen. Most of the patients had mild head trauma (n = 194; 83.3 %). Craniotomy with bone fragment replacement was commonly performed (n = 102; 43.8 %) followed by simple fracture elevation in 42.5 % (n = 99;). Most of the patients experienced an uneventful outcome (n = 227; 97.4 %). The death rate was very low (0.9 %; n = 2).

Conclusion

Depressed skull fractures constitute a common traumatic neurosurgical pathologies met at Niamey National Hospital. CT Scan constitutes the main diagnosis tool. Its treatment is often surgical.