Head > Skull Fractures

What are Skull Fractures?

Donald M. Palatucci, M.D., neurology consultant for the Oakland Athletics, has not seen many sports-related skull fractures. But he does recall one in particular. It occurred in 1988 when Athletics catcher Terry Steinbach was hit in the head by a pitch, resulting in a basilar skull fracture - a fracture located at the base of the skull. "I saw him and he was like all the jocks, saying, ‘I'm OK, doc; nothing wrong with me, I'll be able to play.'" Dr. Palatucci says. "Well, he had blood in one [ear], and I told him, ‘No, you're not playing tomorrow. You've got to take a couple weeks off.' "I sent him to an ear, nose and throat guy just to clean out the ear and take a look at the drum, and he did recover fully and didn't lose a lot of time off, but we treated him more conservatively than we would have had he not had that findingÉHe wasn't hospitalized and he wasn't treated because there isn't any specific treatment for that." Thankfully, sports usually are not violent enough to cause skull fractures, certainly not the most serious types. Serious injuries, such as a depressed fracture or a compound skull fracture, in which the skull bone is actually broken, are normally the result of very violent incidents such as automobile accidents. The other two types of skull fractures, the basilar and the linear skull fracture, do sometimes occur in sports. "In civilian practice, skull fractures are not that common, even though head injuries are very common," says Dr. Palatucci. "Skull fractures more commonly occur in motor vehicle accidents than they do in sports. For example, boxers who get knocked out and die, none of those guys have skull fractures. "It would be extremely uncommon to see in sports anything other than a linear skull fracture." The two most common skull fractures are linear fractures and basilar skull fractures.

   A linear fracture is a break in the skull, usually in a thin line.

    This type of injury requires observation and minimum treatment, unless there are symptoms such as severe headache, vomiting, decrease in the level of consciousness, double vision, and dizziness.

"If a person looked OK and it was a simple linear fracture, they probably wouldn't get any more attention that someone who, say, had a concussion and looked OK without the skull fracture," says Dr. Palatucci. "It depends if there is any evidence of associated brain injury. Let's say a guy gets hurt on the football field and he gets an X-ray and a CT scan, and it shows a linear skull fracture. But he's with it, he may have a little headache but he's mentally alert. He would be kept under observation but there's no specific therapy for that. He would perhaps be watched more closely than a guy who had a head injury and didn't have a skull fracture. "[A linear fracture] would be an indicator of a harder blow, and they would kept for observation and kept off the field for a longer period of time, but there would be no other action taken."

    A basilar skull fracture occurs at the base of the skull and is rarely detected by an X-ray.

    Symptoms include bleeding in an ear, bruising around the eyes (despite there being no injury around the eyes), and a black-and-blue mark behind an ear that is called a Battle sign.

"Those people are usually hospitalized for a number of days because they are usually sicker and it's a more severe head injury," says Dr. Palatucci. "It may be associated with loss of hearing if there is blood coming out of the ear, and more headache and more lethargy than a simple linear skull fracture. "When a lay person thinks of a skull fracture, they think you get a bonk on the head, you take an X-ray and you put it up and you see a dark line someplace. But the ones at the base of the brain, the basilar skull fractures, aren't seen on an X-ray because at the base of the brain it's kind of irregular and there are sinus cavities and holes where the cranial nerves and other structures go through. So an X-ray is not sensitive enough to see a fracture back there."