Skull Fracture: Recovery Time (+ Helpful Information)

What are the different types of skull fractures?

First, let’s clearly distinguish between:

• Traumatic brain injury: This term includes various types of injuries, including skull fractures. It means there has been an impact, blow, or force applied to the head.
• Skull fracture: The bone is broken, either cracked or fractured, often due to a blow, fall, or accident.

One can have a traumatic brain injury without a skull fracture. However, you cannot have a skull fracture without a traumatic brain injury.

In this article, I focus on skull fractures and do not cover traumatic brain injuries in general.

Symptoms of a skull fracture:

Here are the main symptoms of a skull fracture. There can be one or several:

• Localized pain and tenderness at a specific location on the skull
• Swelling or deformity of the affected area
• Bruising or contusions around the fractured zone
• Bleeding from the nose, ears, or eyes
• Severe headaches
• Nausea and vomiting
• Changes in behavior, confusion, or loss of consciousness
• Vision, hearing, or speech problems
• Seizures or abnormal movements

Some people wonder if it’s possible to have a skull fracture without visible bleeding externally. Yes, it’s possible.

In some cases, the bone can fracture without damaging the surrounding blood vessels, limiting the presence of external bleeding. However, a skull fracture can still cause internal bleeding or hematomas that are not visible externally.

Faced with these symptoms and depending on how the accident occurred, additional examinations may be required:

• X-ray: It’s not always sensitive enough to detect minor fractures or fractures that do not penetrate the entire thickness of the bone.
• CT scan: This is the most commonly used imaging technique.
• MRI: Sometimes used.

Various Types of Broken Skull

Skull fractures can be classified into several types based on their location and characteristics.

1. Linear Skull Fracture: A fracture that occurs in a straight line without significant displacement of bone fragments. It can be thin or more extensive.
2. Depressed Skull Fracture: Involves a sinking or depression of the skull. Bone fragments may press on the brain, potentially requiring surgical intervention to realign the fracture and protect the brain.
3. Comminuted Skull Fracture: Multiple bone fragments result from violent trauma. Fragments can be projected into the surrounding tissues, leading to additional brain injuries.
4. Open Skull Fracture: The fracture creates a communication between the outside of the skull and the cranial cavity, for example, in cases of penetrating injuries or significant trauma. This exposes the brain to the risk of infection.
5. Basilar Skull Fracture: Affects the base of the skull, usually near the back. It may be associated with symptoms such as ear or nose bleeding, bruising around the eyes (battle sign), and neurological disorders.

Difference Between Adults and Children

Skull fractures in children have some specificities compared to fractures in adults because the skull is still developing in young children.

Traumatic brain injuries are not necessarily more severe or less severe in children. They are just different, especially in babies and young children.

Here are three main specificities when there is a traumatic brain injury in a child (with or without a skull fracture):

1. In young children, the sutures that connect different parts of the skull are not yet fully fused. This can allow some flexibility and deformability, reducing the risk of fractures.
2. Due to the flexibility of the skull in children, “depressed” (indented) skull fractures are less frequent than in adults. They are more often linear fractures or comminuted fractures.
3. Children are more likely to have associated brain injuries, such as bruises or intracranial bleeding. Therefore, traumatic brain injuries in children are monitored more closely than in adults.

What Are the Consequences of a Skull Fracture?

The consequences of a skull fracture can vary depending on:

• The severity of the fracture.
• Its location.
• The general condition of the person.
• The possible presence of associated injuries, such as brain injuries or fractures in other parts of the body.

Here are three possible types of consequences:

Your skull fracture is relatively benign. You have temporary symptoms such as pain, bruising, or swelling.

Over time, these symptoms improve, and you fully recover. Hair usually begins to regrow in 1 to 3 weeks (Simon 2022).

Your fracture is more significant. In this case, the three most common complications (which are still rare) are:

• Brain injuries: This means that your brain, located in the skull, may be somewhat (or severely) damaged.

This can cause headaches, memory problems, concentration issues, sleep disturbances, mood changes, balance and coordination problems, sensory issues, speech and language problems, vision problems, difficulties with daily activities, cognitive impairments, and motor deficits, among others.

These brain injuries are due to:

• Cerebral contusions (tissue damage due to direct impact).
• Hematomas (accumulation of blood).
• Diffuse axonal injuries (damage to nerve fibers).
• Infection, such as meningitis. The risk of meningitis in case of basilar skull fracture is 5% (Simon 2022). Vascular trauma.

In rare cases, the skull fracture is fatal.

Especially when there is:

• A fracture of the occipital bone (2010).
• A severe fracture of the cranial vault associated with a severe fracture of the base of the skull (Fujiwara 2021).

What Is the Healing Time When You Break Your Skull?

Again, the consolidation time of your fracture will depend on many parameters. Specific to the fracture but also to your general health and your genetic predispositions concerning recovery.

All other things being equal, the skull has a relatively fast consolidation capacity compared to some other bones in the body, such as limb bones. This is because there are many blood vessels in the skull, which promotes blood circulation and the supply of nutrients necessary for healing.

That’s why most basal skull fractures heal in a maximum of 5 to 10 days in adults (Simon 2022). But in some people, it may take several months.

In children, the healing time for a skull fracture is much longer than in adults. In children up to 3 years old (Lasiecka 2023):

• The average healing time for a skull fracture is three and a half months.
• The minimum observed time is 22 days.
• The maximum healing time is seven and a half months.

What Is the Total Healing Time for a Skull Fracture?

We need to agree on what we mean by “healing time”:

• The time for bone healing (already seen in the previous paragraph)?
• The healing time for associated injuries: other fractures, vascular, nerve injuries, etc.?
• The time needed to return to one’s life before the injury?

Once again, there are enormous differences depending on the cases.

Some people will take only a few days or weeks to fully regain their life before a skull fracture. Others will need several months. And others will have long-term or medium-term consequences.

Doctors, surgeons, and physical therapists who know your personal situation, have access to your entire medical record and test results, and can discuss with you directly are best placed to provide a more personalized answer to this question.

Keeping in mind that even with all this information, making a precise prognosis is almost impossible. Not because we don’t want to do it, but because too many factors come into play to make specific recovery hypotheses.

What to Do in Case of a Skull Fracture?

I will distinguish between 2 situations:

1. The emergency situation.
2. The medical and rehabilitative management following the trauma.

What to Do Urgently if Someone Has a Skull Fracture?

Here are the 4 things to do if you are facing someone who probably has a skull fracture.

1. Immobilize the head and neck until help arrives. Avoid moving the person unless there is an immediate danger.
2. Stop the bleeding: apply firm but gentle pressure on the wound using a clean cloth or sterile gauze. Avoid putting direct pressure on the fracture itself.
3. Do not apply direct pressure to the fractured bones: avoid touching or manipulating the parts of the head that are swollen, deformed, or bleeding.
4. Keep the person at rest: Encourage the person to stay calm and still until medical help arrives. Protect them from the sun or cover them depending on the temperature.

Personal note: On the first day of my first job as a licensed physiotherapist, I was the first to arrive in front of a person who had just fractured their skull by falling backward from their wheelchair, in a small local hospital. I failed to convince those who arrived after me that it was better to leave the person on the ground by maintaining head support, waiting for a doctor.

The others absolutely wanted to put the patient on a stretcher so that he would no longer be in the sun, then change him (he had urinated on himself) to be clean for his imaging exams.

The patient died the next day. Of course, there is no certainty that we could have avoided this outcome. Nevertheless, I think it is important to occasionally recall these guidelines for dealing with significant head trauma and an unconscious person.

What Is the Treatment for a Skull Fracture?

Once the diagnosis of a skull fracture is made, you have, at a minimum, medical monitoring. You are given a follow-up appointment in a few days, weeks, or months, where you are kept under observation at the hospital.

If there are associated injuries, these injuries are treated.

In some cases, surgery is necessary:

1. To reduce the fracture: realign the fractured fragments and stabilize the fracture using plates, screws, or other fixation devices.
2. To remove bone fragments or debris.

Medications are given to relieve symptoms (especially pain) or other issues. However, medications are not intended to accelerate bone consolidation.

Rehabilitation is sometimes necessary. In this case, physiotherapy sessions are often prescribed. This is more common when there are neurological problems, which is one of the possible complications of a severe skull fracture.

In severe traumatic brain injuries, recovery can extend over several years. Most recovery occurs in the first two years, but some people may still regain motor or cognitive abilities 5 to 10 years after the cranial injury (Fleminger 2005).

Do We Retain Sequelae After a Skull Fracture?

There are various scenarios, and it’s challenging to predict in advance whether you will have sequelae after a skull fracture.

When there are sequelae, they are more often neurological and therefore more related to the head trauma and its consequences on the brain than to the bone issue.

Sequelae can also be linked to complications such as infection.

But remember that people who have had significant skull fractures recover over several months or even years after the fracture (especially if they are young), thanks to brain plasticity.

After a head injury, certain regions of the brain may be damaged, leading to alterations in cognitive, motor, sensory, or emotional functions. However, other parts of the brain can compensate for these damages by taking over the affected functions.

This can happen through the reassignment of existing neural connections or the formation of new connections: it’s called brain plasticity.

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See also: my blog on physical therapy