Bone Cements in Depressed Frontal Bone Fractures

Abstract

Skull fractures can be classified into four major types; linear, depressed, diastatic, and basilar. Of these, a depressed skull fracture presents a high risk of increased intracranial pressure or hemorrhage to the brain. A compound depressed skull fracture results when a laceration over the fracture exposes the internal cranial cavity to the outside environment. Such depressed skull fractures are indicated for elevation if the defect is more than 10 mm and in the presence of brain injury. Frontal bone contour defects result in marked facial deformity which becomes obvious to the observer. Esthetic correction of the depressed frontal bone fracture can be done with autogenous bone grafts or alloplastic materials. Autogenous bone grafts are meant to be the gold standard method of reconstruction, but they harbor the risk of donor-site morbidity. There are various materials available for the reconstruction of depressed frontal bone fractures. This is a case report which illustrates the use of easily injectable, self-setting calcium phosphate bone cement in the correction of a depressed frontal bone fracture measuring approximately 3 cm × 2.5 cm × 1.5 cm.

Keywords: Bone cement; calcium phosphate cements; contour defects; craniofacial trauma; frontal bone; reconstruction.

Figure 1

Preoperative presentation of the patient

Figure 2

Computed tomography revealing left frontal bone fracture and Lefort I fracture

Figure 3

(a) Exposure of fracture site, (b) calcium phosphate bone cement, (c) reconstruction of the defect with the bone cement, (d) closure done in layers

Figure 4

Postoperative frontal view of the patient depicting bilateral symmetry of the frontal bone

Figure 5

(a) Preoperative axial section of computed tomography demonstrating the depressed frontal bone fracture, (b) postoperative axial section of computed tomography demonstrating the reconstructed site

Figure 6

Classification of frontal bone fracture. Type 1 fractures are isolated to the frontal sinus without a vertical trajectory (purple). Type 2 fractures are vertically oriented and extend into the orbit but not the frontal sinus (blue). Type 3 fractures are vertically oriented and extend into the frontal sinus but not the orbit (yellow). Type 4 fractures are vertically oriented and extend into ipsilateral frontal sinus and orbit (green). Type 5 fractures extend into the frontal sinus and extend into the orbit on both sides of the face or the contralateral side of the face (red)

Figure 7

Skull base penetration depths. Depth A fractures involve the anterior table of the frontal bone with or without posterior table involvement and do not extend into the anterior cranial fossa (purple). Depth B fractures involve the floor of the anterior cranial fossa (blue). Depth C fractures involve the middle cranial fossa (yellow). Depth D fractures extend into the posterior cranial fossa (red)