The practice of surgery . discovered an adherent dura and a depressed scar overBrocas convolution. An experience of such cases gives one pause, and FRACTURES OF THE SKULL G21 leads to the conviction that any persistent sjmptoms of intracranialdamage call for a trephining and exploration within the skull. Such considerations will suggest to the reader the extreme difficultyof making a prompt and exact diagnosis of head injuries, and will indi-cate also the uncertainty of the surgeon when he comes to their treat-ment. The unique conformation of the skull adds to the difficulty ofdiagnosis, for i
The practice of surgery . discovered an adherent dura and a depressed scar overBrocas convolution. An experience of such cases gives one pause, and FRACTURES OF THE SKULL G21 leads to the conviction that any persistent sjmptoms of intracranialdamage call for a trephining and exploration within the skull. Such considerations will suggest to the reader the extreme difficultyof making a prompt and exact diagnosis of head injuries, and will indi-cate also the uncertainty of the surgeon when he comes to their treat-ment. The unique conformation of the skull adds to the difficulty ofdiagnosis, for in the skull we have to deal with an outer table, a diploe(corresponding to the medullary cavity of long bones), and an inner the case of a simple fracture it may be possible to determine the extentof the injury by touch or by consideration of the immediate S3^, in young children, after an injury, there may exist a depressionof the skull, without fracture, corresponding to the so-called green-stick. Fig. 404.—Incircling fracture of the skull (Keens Surgery). fracture in the long bones. While a simple crack of the outer tableis harmless enough, it is often impossible to say whether or not the innertable be damaged also, and we know that a trifling lesion of the outertable often is associated with an extensive lesion—splintering anddepression—of the inner table. One must distinguish also the difference, often vital, between simplefracture of the vault and fracture of the base of the skull, bearing in mindalways that the two maj^ be associated, on the one hand, as independentlesions, or, on the other, as a continuous lesion, in as much as a crackbeginning in the base mary run around to the vault (fracture by exten-sion) partially or entirely incircling the skull. Conventional writingsdescribe independent fractures of the vault and independent fractures of 622 THE HEAD AND SPINE the base, but clinicallj one may not always draw such a distinctionbetween
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1910
