From the Research
Management of a scalp laceration with an associated scalp fracture requires prompt surgical evaluation and intervention, with a focus on stabilizing the patient, controlling bleeding, and assessing for underlying brain injury, as highlighted in the study by 1. The patient should be stabilized and transferred to an emergency department for neurosurgical consultation. Initial management includes gentle cleansing of the wound, control of bleeding with direct pressure, and assessment for signs of underlying brain injury. Surgical exploration is necessary to evaluate the extent of the fracture and repair the laceration. The wound should be thoroughly irrigated with sterile saline, and foreign debris removed. Depending on the fracture type, neurosurgical intervention may be required to elevate depressed fragments or repair dural tears. Prophylactic antibiotics such as cefazolin 1-2g IV are typically administered to prevent infection, particularly with open fractures, as noted in the general management of scalp lacerations 2. Tetanus prophylaxis should be updated if needed. Pain management with acetaminophen or NSAIDs is appropriate, avoiding opioids if possible to allow for neurological monitoring. Close follow-up is essential to monitor for complications such as infection, cerebrospinal fluid leak, or neurological deterioration. This approach is critical because scalp fractures may be associated with intracranial injuries that require prompt identification and treatment to prevent serious complications, with studies suggesting that scalp lacerations are associated with intracranial injuries in about 20% of patients with mild traumatic brain injury 1. Key considerations in management include:
- Prompt recognition and treatment of the scalp laceration to prevent complications, as emphasized by the case report 3
- Thorough examination and cleaning of the wound to assess its extent and remove debris
- Neurosurgical consultation for evaluation and management of potential underlying brain injuries
- Use of prophylactic antibiotics to prevent infection, particularly in open fractures
- Close monitoring for signs of neurological deterioration or other complications.