skull fractures vs accessory sutures

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

Pediatric skull fractures : Imaging Pearls

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

Axial CT scan of Brain in Bone window setting

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

3D CT

Accessory sutures in children below 4 years of age

Skull sutureSclerotic Edges

Sharp Lucent

Fracture Line

Skull sutureSclerotic edges Sharp

lucent

Fracture Line

Skull suture Zig Zag

Linear

Fracture Line

Zig Zag Vs Linear Line

Zig Zag vs Linear

Skull suture Joins Other Sutures

CrossesFracture Line

Skull suture Joins Crosses

Fracture line

Skull sutureBilateral/symmetrical

Unilateral/Asymmetrical

Fracture Line

Skull sutureBilateral/Symmetrical

Unilateral/Asymmetrical

Fracture Line

Widening of fracture line

Plain film radiography can suffice

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.

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

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.