WordNet

interrupt, break, or destroy; "fracture the balance of power"
breaking of hard tissue such as bone; "it was a nasty fracture"; "the break seems to have been caused by a fall" (同)break
fracture a bone of; "I broke my foot while playing hockey" (同)break
become fractured; "The tibia fractured from the blow of the iron pipe"
break (a bone); "She broke her clavicle"
break into pieces; "The pothole fractured a bolt on the axle"
violate or abuse; "This writer really fractures the language"
the act of cracking something (同)crack, cracking
of primary importance (同)primary
serving as or forming a base; "the painter applied a base coat followed by two finishing coats" (同)base

PrepTutorEJDIC

〈U〉(特に)骨を折ること;骨を折った状熊 / 〈C〉割れ(裂け)目,(鉱物の)破砕面 / 〈足・腕などを〉‘を'骨折する;…‘を'砕く / 骨折する;砕ける
基底の,基部の / 基礎的な,基本的な

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/08/28 15:08:14」(JST)

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A basilar skull fracture (or basal skull fracture) is a fracture of the base of the skull, typically involving the temporal bone, occipital bone, sphenoid bone, and/or ethmoid bone.

This type of fracture is rare, occurring as the only fracture in just 4% of severe head injury patients.^[1]^[2]

Such fractures can cause tears in the membranes surrounding the brain, or meninges, with resultant leakage of the cerebrospinal fluid (CSF). The leaking fluid may accumulate in the middle ear space, and dribble out through a perforated eardrum (CSF otorrhea) or into the nasopharynx via the eustachian tube, causing a salty taste. CSF may also drip from the nose (CSF rhinorrhea) in fractures of the anterior skull base, yielding a halo sign^[where?]. These signs are characteristic for basilar skull fractures.^[3]

Signs and symptoms

A basilar skull fracture as seen on CT

Battle's sign -- bruising of the mastoid process of the temporal bone.
Raccoon eyes -- bruising around the eyes, i.e. "black eyes"
Cerebrospinal fluid rhinorrhea
Cranial nerve palsy
Bleeding (sometimes profuse) from the nose and ears
Hemotympanum
Conductive or perceptive deafness, nystagmus, vomitus
In 1-10% of patients, optic nerve entrapment occurs.^[3] The optic nerve is compressed by the broken skull bones, causing irregularities in vision.
Serious cases usually result in death

Pathophysiology

Diagram showing bones that may be involved in a basilar skull fracture

Basilar skull fractures include breaks in the posterior skull base or anterior skull base. The former involve the occipital bone, temporal bone, and portions of the sphenoid bone; the latter, superior portions of the sphenoid and ethmoid bones. The temporal bone fracture is encountered in 75% of all basilar skull fractures and may be longitudinal, transverse or mixed, depending on the course of the fracture line in relation to the longitudinal axis of the pyramid.^[4]

Bones may be broken around the foramen magnum, the hole in the base of the skull through which the spinal cord exits and becomes the brain stem, creating the risk that blood vessels and nerves exiting the hole may be damaged.^[5]

Due to the proximity of the cranial nerves, injury to those nerves may occur.^[3] This can cause palsy of the facial nerve or oculomotor nerve or hearing loss due to damage of cranial nerve VIII.^[3]

Management

Evidence does not support the use of prophylactic antibiotics regardless of the presence of a cerebral spinal fluid leak.^[6]

Prognosis

Non-displaced fractures usually heal without intervention. Patients with basilar skull fractures are especially likely to get meningitis.^[7] Unfortunately, the efficacy of prophylactic antibiotics in these cases is uncertain.^[8]

Temporal bone fractures

Acute injury to the internal carotid artery (carotid dissection, occlusion, pseudoaneurysm formation) may be asymptomatic or result in life-threatening bleeding. They are almost exclusively observed when the carotid canal is fractured, although only a minority of carotid canal fractures result in vascular injury. Involvement of the petrous segment of the carotid canal is associated with a relatively high incidence of carotid injury.^[9]

Society and culture

Basilar skull fractures are a common cause of death in many motor racing accidents. Drivers who have died as a result of basilar skull fractures include Formula One driver Roland Ratzenberger; INDYCAR drivers Bill Vukovich Sr., Tony Bettenhausen Sr., Floyd Roberts, and Scott Brayton; NASCAR drivers Dale Earnhardt Sr., Adam Petty, Tony Roper, Kenny Irwin Jr., Neil Bonnett, John Nemechek, J.D. McDuffie, and Richie Evans; CART drivers Jovy Marcelo, Greg Moore, and Gonzalo Rodriguez; and ARCA drivers Blaise Alexander and Slick Johnson.^{[citation needed]}

To prevent this injury, all major motor sports sanctioning bodies now mandate the use of head and neck restraints, such as the HANS device.^{[citation needed]} To this day the HANS device has multiple times demonstrated its life saving abilities. Examples of drivers surviving thanks to the HANS device are Jeff Gordon at the 2006 Pocono 500, Robert Kubica at the 2007 Canadian Grand Prix, and Max Verstappen at the 2015 Monaco Grand Prix.^{[citation needed]}

References

^ Graham, David I.; Gennarelli, Thomas A. (2000). "Pathology of Brain Damage After Head Injury". In Cooper, Paul Richard; Golfinos, John. Head Injury. McGraw-Hill. pp. 133–54. ISBN 978-0-8385-3687-2.
^ "Overview of Adult Traumatic Brain Injuries" (PDF). Orlando Regional Healthcare, Education and Development. 2004. Archived from the original (PDF) on February 27, 2008.
^ ^a ^b ^c ^d Pediatric Head Trauma at eMedicine
^ Skull Fracture at eMedicine
^ "About Brain Injury". Brain Injury Association of America. October 12, 2012.
^ Ratilal, Bernardo O; Costa, João; Pappamikail, Lia; Sampaio, Cristina; Ratilal, Bernardo O (2015). "Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures". The Cochrane Database of Systematic Reviews. 4: CD004884. doi:10.1002/14651858.CD004884.pub4. PMID 25918919.
^ Dagi, T.Forcht; Meyer, Frederick B.; Poletti, Charles A. (1983). "The incidence and prevention of meningitis after basilar skull fracture". The American Journal of Emergency Medicine. 1 (3): 295–8. doi:10.1016/0735-6757(83)90109-2. PMID 6680635.
^ Butler, John. "Antibiotics in base of skull fractures". BestBets. Retrieved 2014-03-22.
^ Resnick, Daniel K.; Subach, Brian R.; Marion, Donald W. (1997). "The Significance of Carotid Canal Involvement in Basilar Cranial Fracture". Neurosurgery. 40 (6): 1177–81. doi:10.1097/00006123-199706000-00012. PMID 9179890.

External links

-2093678563 at GPnotebook

UpToDate Contents

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1. 成人における昏迷および昏睡 stupor and coma in adults
2. 成人における顔面外傷 facial trauma in adults
3. 小児における胸腔内損傷の概要 overview of intrathoracic injuries in children
4. 小児及び思春期におけるスクリーニングテスト screening tests in children and adolescents
5. 母斑性基底細胞癌症候群 nevoid basal cell carcinoma syndrome

English Journal

Greenland supraglacial lake drainages triggered by hydrologically induced basal slip.

Stevens LA1, Behn MD2, McGuire JJ2, Das SB2, Joughin I3, Herring T4, Shean DE3, King MA5.
Nature.Nature.2015 Jun 4;522(7554):73-6. doi: 10.1038/nature14480.
Water-driven fracture propagation beneath supraglacial lakes rapidly transports large volumes of surface meltwater to the base of the Greenland Ice Sheet. These drainage events drive transient ice-sheet acceleration and establish conduits for additional surface-to-bed meltwater transport for the rem
PMID 26040890

Characterization of damage mechanisms associated with reference point indentation in human bone.

Beutel BG1, Kennedy OD2.
Bone.Bone.2015 Jun;75:1-7. doi: 10.1016/j.bone.2015.01.019. Epub 2015 Feb 7.
Measurement of bone mineral density (BMD) is the clinical gold standard in cases of compromised skeletal integrity, such as with osteoporosis. While BMD is a useful measurement to index skeletal health, it is also limited since it cannot directly assess any mechanical properties. The ability to dire
PMID 25659950

Basal haemoglobin levels as prognostic factor for early death in elderly patients with a hip fracture - A twenty year observation study.

Kovar FM1, Endler G2, Wagner OF3, Jaindl M4.
Injury.Injury.2015 Jun;46(6):1018-22. doi: 10.1016/j.injury.2015.01.010. Epub 2015 Jan 22.
INTRODUCTION: Hip fractures are a significant cause of mortality and morbidity in the elderly. This study investigated the relationship between initial haemoglobin (Hb) levels and a prognostic parameter for outcome in those patients.PATIENTS AND METHODS: A total of 3595 consecutive patients with dia
PMID 25704141

Japanese Journal

Petrology and chemistry of basal lherzolites above the metamorphic sole from wadi sarami central oman ophiolite

Zaki Khedr Mohamed,Arai Shoji,Python Marie
Journal of Mineralogical and Petrological Sciences 108(1), 13-24, 2013
… We studied basal lherzolites that are exposed along the metamorphic sole at the base of the central Oman ophiolite (Wadi Sarami). … The Type II lherzolites, which occur near the paleo-fracture zone located to the east of Wadi Sarami, represent a remnant of asthenospheric materials trapped at the base of oceanic lithosphere mantle (Type I) during detachment and obduction. …
NAID 130003365166

OS2019 多結晶マグネシウム合金の疲労き裂進展挙動に及ぼすミクロ組織の影響(OS20-4 疲労と強度,OS-20 HCP金属の実験力学と計算力学)

森田繁樹,大野信義,玉井富士夫,川上雄士
M&M材料力学カンファレンス 2011, "OS2019-1"-"OS2019-3", 2011-07-16
… crack face was perpendicular to basal plane of each grain. … Fracture surfaces of the fine-grained and coarse-grained specimens showed various directional steps independent of macroscopic crack growth direction. …
NAID 110009689383

中手骨頚部, 基部骨折に対する condylar plate の使用経験

廣岡孝彦,藤井淳一,小瀬靖郎,川上直明,東條好憲,名越充
骨折 33(2), 245-249, 2011-05-25
NAID 10029543283

Related Pictures

Basilar Skull Fractures - YouTube Basilar Skull Fracture - Anatomical Justice Head & Spinal Cord Injuries #27 at Tulsa Community College - StudyBlue Basilar Skull Fracture | INFOMEDIA TRIAL SOLUTIONS, INC. 10 Signs and Symptoms Of Basilar Skull Fracture (Basal Skull Fracture) - YouTube Pin on Синдромы Skull Fracture, Basilar; Basilar Skull Fracture; Battle Sign Study Medical Photos: Basilar Skull Fracture

★リンクテーブル★

リンク元	「頭蓋底骨折」
関連記事	「basal」「fracture」

「頭蓋底骨折」

Basilar skull fracture
	A subtle temporal bone fracture as seen on CT in a person with a severe head injury
Classification and external resources
Specialty	emergency medicine
ICD-10	S02.1
ICD-9-CM	801.1
eMedicine	med/2894
	[edit on Wikidata]