skull fractures vs accessory sutures

Dr. Surendra Bishnoi DNB Resident(1 st Year), Pediatric skull fractures : Imaging Pearls

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$Page 1: skull fractures vs accessory sutures$

Dr. Surendra BishnoiDNB Resident(1st Year),Saifee Hospital, Mumbai.

Pediatric skull fractures : Imaging Pearls

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7 year old boy with H/O Fall.No Neurological deficit.

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Axial CT scan of Brain in Bone window setting

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3 year old female ,trauma, neurological deficit . CT Brain Plain

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3D CT

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Accessory sutures in children below 4 years of age

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Skull sutureSclerotic Edges

Sharp Lucent

Fracture Line

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Skull sutureSclerotic edges Sharp

lucent

Fracture Line

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Skull suture Zig Zag

Linear

Fracture Line

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Zig Zag Vs Linear Line

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Zig Zag vs Linear

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Skull suture Joins Other Sutures

CrossesFracture Line

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Skull suture Joins Crosses

Fracture line

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Skull sutureBilateral/symmetrical

Unilateral/Asymmetrical

Fracture Line

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Skull sutureBilateral/Symmetrical

Unilateral/Asymmetrical

Fracture Line

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Widening of fracture line

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Plain film radiography can suffice

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Imaging

• Plain film radiography is often the most cost effective, initial imaging modality of choice for evaluating fractures in suspected cases of non-accidental trauma.

• Head CT is obtained in cases where there is clinical suspicion for intracranial injury.

• 3-D reconstructions are often requested from the 3-D lab for patients with complex head CT findings.

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Five Point formula. Symmetrical, Zig-Zag

with Sclerotic border and merging pattern is Suture.

Clinical scenario and embryological anatomy is best supplement.

Take Home Message

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References1. Sanchez T, Stewart D, Walvick M, Swischuk L (2010) Skull Fracture vs. accessory sutures: how can we tell the difference? Emergency Radiology 17 (5): 413 – 418. 2. Glass RB, Fernbach SK, Norton KI, Choi PS, Naidich TP (2004) The Infant Skull: A Vault of Information . Radiographics 24, (507 – 522). 3. Mulroy MH, Loyd AM, Frush DP, Verla TG, Myers BS, Bass CR (2012) Evaluation of pediatric skull fracture imaging techniques . Forensic Science International 214: 167 – 72.

4. Choudhary AK, Jha B, Boal DK, Dias M (2010) Occipital sutures and its variations: the value of 3D-CT and how to differentiate it from fractures using 3D-CT? Surgical Radiology Anatomy 32: 807 – 816.

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