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FIGURE 113.3 Linear skull fracture. An axial CT scan with bone windows
demonstrates a closed linear nondisplaced skull fracture through the left orbital roof.

Current Evidence
Unilateral, linear skull fractures account for approximately 75% of pediatric
skull fractures ( Fig. 113.3 ). This estimate applies to both accidental and
nonaccidental pediatric skull fractures. The incidence of underlying
intracranial injury ranges from 15% to 30%. Complicated skull fractures
may include fractures that cross suture lines, complex, burst, depressed,
diastatic, bilateral, multiple, or open fractures. Figure 113.4 shows a closed,
depressed skull fracture. Complicated fractures have, not only an increased
likelihood of underlying intracranial injury, but also an increased
association with nonaccidental trauma. Of the complex fractures, ones that



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