Penetrating skull fracture by a wooden object: Management dilemmas and literature review
A female 75-year-old farmer, while working in her field, accidentally fell onto a piece of wood that pierced through her skull [] and was directly brought to our emergency department about 8 hours following the alleged trauma. She was conscious throughout the incident with a brief history of vomiting but no seizure episode was present. During admission, her Glasgow coma scale (GCS) was 15 with both pupils equal and reactive. A large open wound at her left frontal region size 5×4 cm with a penetrating wood was visible.\nA CT scan of her brain was performed emergently. The bone window CT demonstrated bone fragments penetrating her brain with underlying hematoma [Figure and ]. Upon completion of all the necessary diagnostic studies, she was taken promptly to the operating room.\nPatient was positioned supine with her head slightly turned to the right. The same wound was used as one of the margin of a ‘S’ shape incision and scalp flap was retracted. On raising the flap, a large wooden object size 4×3 cm was found piercing the bone and surrounding tissue. A craniotomy was undertaken using four burr holes surrounding the object for better operative exposure []. During careful removal of the object, dural tear size 3×2 cm was found. We carefully performed necrotic tissue debridement and removal of bone fragments piercing the brain matter []. There was significant bleeding during hematoma evacuation which was effectively controlled using gel foam and pressure. Wound was irrigated with saline and gentamicin antibiotic. The dural defect was then covered with autologous graft [].\nThis surgical procedure was considered as a successful surgery. The patient was allowed to be awakened from general anesthesia in the operating room. Post operative recovery was good and patient was discharged on the tenth day after the surgery. During 3-month follow-up, patient is doing well without any neurological deficits.