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.
Table 11. - Classification of craniocerbral
injuries
Scalp |
Skull |
Brain |
Open:
puncture
laceration
avulsion
Closed:
contusion
|
depressed fracture
comminuted fracture
linear fracture
|
Open:
penetrating injury
Closed:
diffuse parenchymal injury
focal intracranial hematomas:
extradural
subdural
intracerebral
|
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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