Accidental traumatic head injury in infants and young children

Abstract

This article will discuss accidental head injuries in infants and young children. The first category of injury is the crushing head injury. Static forces applied slowly to the head result in multiple fractures of the skull and contusions and lacerations of the brain resulting from the bone fragments striking the brain. This article will discuss the subject of short falls in young children and the resulting head injuries. Because falls are frequent events in early life, many cases have been collected and many papers written on the subject. Study of these cases is informative about the injuries likely to occur in these falls. Most often, only a minor contact injury such as scalp bruise or laceration results. In a 2 to 3% of falls, a simple linear skull fracture occurs and the majority of these are uneventful in terms of neurological deficit or intracranial bleeding. In about 1% of the fractures, an epidural or subdural hemorrhage occurs. Each of these forms of contact hemorrhages will be discussed and illustrated. While these are relatively rare injuries, it is essential that they can be identified as consistent with an accidental mechanism so that an erroneous diagnosis of inflicted injury is not made.

Figure 1

A. A 21‐month‐old male with a crushing head injury after a vehicle ran over the child in a driveway. Head of child showing abrasions from wheel and skull deformity. B. Skull showing multiple fractures and deformities from crushing injury. C. Brain showing lacerations and contusions from crushing injury. D. Coronal section of brain showing fracture lacerations and fracture contusions of brain.

Figure 2

A. A 2‐year‐old child struck on head with object, with a fracture of right parietal bone and an 80‐mL epidural hemorrhage over the right temporoparietal convexity. B. Marked flattening of right parietal lateral convexity with fracture contusions of right superior and middle temporal gyri. C. Coronal section of brain showing marked flattening of right parietal lobe.

Figure 3

A. A 4‐month‐old male (Case 1 in Table 1), who fell from bed and struck a table, with fractures of the right frontal bone and the right orbital plate. B. Epidural hemorrhage over right anterior cranial fossa. C. Fracture of right orbital plate.