Low velocity injuries include a child falling a short distance, an accidental blow tothe head as with a baseball bat, or an aggressive tackle in a football game. These injuries are usually mild and usually require observation only. Examples of a high velocity injury include a fall from an upper story window, a pedestrian being struck by a moving car, or automobile accidents. Even in the absence of neurological dysfunction children who have had this type of injury are ususally observed in the hospital. Morphology of Injury Skull fractures, may be in the cranial vault or skull base and be linear or stellate, depressed or non depressed.
Most skull fractures are obvious on plain skull X-rays.
Inasmuch as there is a common association of subgaleal hematoma and skull fracture, a skull X-ray is indicated for a child with a subgaleal hematoma. This is also a common fracture in infants who have fallen from a height. In most cases they do not require elevation as the brain pulsation will push the bone out and restablish a normal skull contour within a few weeks. Depressed fractures are almost invariably associated with high velocity injury and may result in brain injury. Therefore a CAT scan is mandatory, even in the absence of neurological dysfunction.