Linear Frontal Bone Fractures - Clinical and Surgical Profile: A Retrospective Study

Background: Linear frontal bone fractures are common injuries in road traffic accidents. Pneumocephalus and CSF (cerebrospinal fluid) leak are both factors influencing their outcome. Persistent pneumocephalus and CSF leak are main indications for surgical treatment. Objectives: Surgical indications are rarely discussed in linear frontal bone fractures. We report results on patients with linear frontal bone fractures, clinical data, management, surgical indications and outcome. Methods: From 2011 to 2015, 121 patients were admitted to our institution with a diagnosis of frontal bone fractures (compound depressed fractures excluded). Fractures were classified into three types, Type A: fracture involving anterior wall of the frontal sinus; Type B: fracture involving posterior wall of the frontal sinus and Type C: fracture of frontobasal region without involving the frontal sinus. All patients were followed for more than 6 months. Results: A total of 112 patients were conservatively treated with standard pneumocephalus protocol. Nine patients underwent surgical intervention. The indications for surgery were the presence of persistent pneumocephalus in CT scan and persistent CSF leak. The presence of pneumocephalus or CSF leak in Type B patients sinus cranialisation with repair of the defect were the variables mainly influencing the outcome (P < 0.001). Conclusions: Frontal bone fracture needs careful attention to prevent its complications such as a CSF leak and meningitis. Patients need clinical and radiological evaluation. Patients with persistent CSF leak or pneumocephalus should always be treated surgically and others should be managed conservatively