Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXII: Craniocerebral Injury

Classification

United States Department of Defense

Craniocerebral injuries are classified according to the type and extent of injury sustained by the scalp, the skull, and the brain and whether the injury is open or closed.

In open injuries, the scalp may be punctured, lacerated, or avulsed. In closed injuries, the scalp is not penetrated but is almost always contused.

Skull fractures are classified as linear, comminuted, and depressed. If open, they are termed compound. It is rare to have comminuted or depressed skull fractures without an overlying scalp laceration. It is important to determine whether fractures cross the meningeal vascular markings or the dural venous sinuses of the skull and whether they involve the paranasal sinuses or mastoid air cells. The depth of fracture depression should be measured on tangential X-ray views.

Brain injuries are classified as open (with penetration of the brain) or closed. The category of closed injury encompasses focal intracranial hematomas (extradural, subdural, and intracerebral) and diffuse parenchymal injury. Various combinations of scalp, skull, and brain injuries often coexist.  

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Operational Medicine 2001

Health Care in Military Settings

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