SURGICAL MANAGEMENT OF FRACTURES INVOLVING THE CRANIAL VAULT *

SUMMARY The care of a patient with head injury and/or skull fracture is similar in many respects to any severe injury, but certain special precautions are necessary because of possible alterations in the cerebral function. The care of the client's transport of the patient to the hospital, and the first aid procedures in the hospital are extremely important. Tracheostomies should be performed rather routinely. Administration of oxygen, occasional hypothermia, steroids, hypertonic solutions, braod spectrum antibiotics, maintenance of electrolyte and fluid balance are all critical considerations in the care of the acute head injury. Bone fragmentation in skull fractures, particularly when causing hemorrhage and when they are depressed in cerebral tissue, must be removed. Bone flap craniotomies are performed where fragments are few or large and tissue damage is marked. A craniectomy is performed where fragmentation is severe. No effort to repair the defect is made where temporal muscle “padding” is substantial. It should be emphasized that emergency cranial surgery is generally only feasible by the person at hand. These animals cannot be transported long distances and be expected to survive. This puts the veterinary surgeon on the “firing line,” but the results will be gratifying in many instances.