Depression fractures occur when there is a high-impact trauma to the head in a small surface area. The bone fragments left will be depressed or below the normal surface area of the skull. The fracture is a dent in the head without opening in the skin or the skin is still somewhat intact. Depending on how deep the depressed fracture is, surgery will most likely be needed. After obtaining this kind of injury there can be side effects such as speech, behavioral, sensory, and vision problems (Mayo Clinic). After surgery, rehab will be needed to regain and strengthen cognitive abilities. This injury can also cause bleeding, seizures, and permanent brain damage. Many other injuries can come from a depressed skull fracture such as extradural hematoma (brain bleed between skull and the dura mater), subdural hematoma (brain bleed between skull and brain), cerebral contusions (brain bruise), subarachnoid hemorrhage (brain bleed that surrounds the brain), pneumocephalus (build-up of air in the brain), and cerebral spinal fluid leaks (Hands Clinic). To heal this injury to the skull, requirements are needed. There needs to be a presence of progenitor cells, extracellular matrix, osteoblast, and osteoclast. Osteoblasts help build cells while osteoclasts break down the bone. Bone cells such as osteocytes, osteoblasts, and osteoclasts maintain bone mechanical function. The National Institute of Health states that its bone cell’s main function is “protection, shape, movement and locomotion”(National Institute of Health). Chondrocytes and epithelial cells will also be used to regenerate the bone. Some general body requirements are having an adequate blood supply, energy, nutrients, and minerals. To start the bone regeneration process, angiogenesis must occur. Angiogenesis is the formation of new blood vessels to bring better blood supply to the fracture site for faster healing. After angiogenesis, primary or secondary healing will occur. Primary healing is healing without using cartilaginous callus. A hematoma (bruise) will form, and inflammation will occur. Inflammation starts right after an injury such as a fracture.  Platelets and macrophages will be present at the site. Secondary healing is healing without a cartilage callus. Secondary healing happens when fractured ends of bones do not meet each other. There is also an inflammatory phase just like primary healing. The 4 main stages of bone repair are hematoma formation, granulation tissue formation, bony callus formation, and bone remodeling (National Institute of Health). Using all the steps of bone repair, the healing time can take around 6 months to completely heal. The remodeling process starts around 6 weeks (about 1 and a half months) after the injury occurs. If an infection is present at the injury, which is not common in closed fractures, this can cause more complications and a longer recovery time. In infants, depression fractures are known as ping-pong fractures because their bone is so elastic that it does not break (Swiss Society of Neonatology). It is a dent in an infant’s head with no break in the skull. These injuries can occur during birth and be healed on their own. 

My project shows hand-drawn images to replicate depressed fractures and also includes information to share what a depressed fracture is, how it happens, the healing process, and more. Unless in infants, depressed fractures are generally man-made, this is because it is a small impact area. For example, in TV shows such as CSI, hammers are generally the cause.

Sources:

Prakash, A., Harsh, V., Gupta, U., Kumar, J., & Kumar, A. (2018). Depressed fractures of skull: An institutional series of 453 patients and Brief Review of Literature. Asian journal of neurosurgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898083/ 

SEER Training Modules, Module Name. U. S. National Institutes of Health, National Cancer Institute. Day Month Year (of access) <https://training.seer.cancer.gov/Links to an external site.>. 

Neonatal ping pong fracture. Swiss Society of Neonatology. (n.d.). https://www.neonet.ch/application/files/4915/6628/8267/COTM_2006_11.pdf 

Kalfas, I. H. (2001). Principles of bone healing. Neurosurgical Focus FOC10(4), 1-4. https://doi.org/10.3171/foc.2001.10.4.2Links to an external site.

Vikram Sathyendra. Hands Clinic. October 17, 2013 :https://doi.org/10.1016/j.hcl.2013.08.002Links to an external site.

Huang, J., Zhou, L., Yan, Z. et al. Effect of manual reduction and indirect decompression on thoracolumbar burst fracture: a comparison study. J Orthop Surg Res 15, 532 (2020). https://doi.org/10.1186/s13018-020-02075-w

2 Comments

  1. Depression fractures occur when there is a high-impact trauma to the head in a small surface area. The bone fragments left will be depressed or below the normal surface area of the skull. The fracture is a dent in the head without opening in the skin or the skin is still somewhat intact. Depending on how deep the depressed fracture is, surgery will most likely be needed. After obtaining this kind of injury there can be side effects such as speech, behavioral, sensory, and vision problems. After surgery, rehab will be needed to regain and strengthen cognitive abilities. This injury can also cause bleeding, seizures, and permanent brain damage. Many other injuries can come from a depressed skull fracture such as extradural hematoma (brain bleed between skull and the dura mater), subdural hematoma (brain bleed between skull and brain), cerebral contusions (brain bruise), subarachnoid hemorrhage (brain bleed that surrounds the brain), pneumocephalus (build-up of air in the brain), and cerebral spinal fluid leaks. To heal this injury to the skull, requirements are needed. There needs to be a presence of progenitor cells, extracellular matrix, osteoblast, and osteoclast. Osteoblasts help build cells while osteoclasts break down the bone. Bone cells such as osteocytes, osteoblasts, and osteoclasts maintain bone mechanical function. The National Institute of Health states that its bone cell’s main function is “protection, shape, movement and locomotion”. Chondrocytes and epithelial cells will also be used to regenerate the bone. Some general body requirements are having an adequate blood supply, energy, nutrients, and minerals. To start the bone regeneration process, angiogenesis must occur. Angiogenesis is the formation of new blood vessels to bring better blood supply to the fracture site for faster healing. After angiogenesis, primary or secondary healing will occur. Primary healing is healing without using cartilaginous callus. A hematoma (bruise) will form, and inflammation will occur. Inflammation starts right after an injury such as a fracture. Platelets and macrophages will be present at the site. Secondary healing is healing without a cartilage callus. Secondary healing happens when fractured ends of bones do not meet each other. There is also an inflammatory phase just like primary healing. The 4 main stages of bone repair are hematoma formation, granulation tissue formation, bony callus formation, and bone remodeling. Using all the steps of bone repair, the healing time can take around 6 months to completely heal. The remodeling process starts around 6 weeks (about 1 and a half months) after the injury occurs. If an infection is present at the injury, which is not common in closed fractures, this can cause more complications and a longer recovery time. In infants’ depression fractures, they are known as ping-pong fractures because their bone is so elastic that it does not break. It is a dent in an infant’s head with no break in the skull. These injuries can occur during birth and be healed on their own.

    Amelie Collard
  2. Amelie covers depression fractures and has four sources that she uses to support her evidence. However, the written piece is missing citations within the text to support the evidence they found. I have not found any grammatical errors, but I am not one to correctly identify that due to having reading hindrances. They have a clearly written statement that identifies their objective. Their visual medium is appropriate, but I am unable to fully view it due to it being used as a background photo that only shows a partial image. I would say that their STEAM project is creative. They have an artistic illustration written words to describe what each illustration is. They clearly articulate what parts of the criteria we learned that they used in connection with their idea. They also go into detail on the healing process of a depression fracture. This helps the reader know what they could expect as a result of a depression fracture. One of their links does not go to the direct source. This is not Amelie’s fault as I also had this issue while creating my piece. The link that isn’t working is the SEER link, but when I type the title in to the SEER website, I am able to find the source she cites. Her other three sources are peer review sources as required. It also seems she posted the piece twice. Once as a link and another time as a comment. Overall her STEAM project was clear and concise with a few hiccups like the abstract piece being hard to view and one of her links not working as it should.

    Micah Wilson

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