Surgical management and outcomes of non-missile open head injury: Report of 44 cases from a single trauma centre

Abstract

Objective: To retrospectively analyse the surgical management and outcomes of non-missile open head injuries (NMOHI).

Methods: Forty-four patients who suffered from NMOHI were included. The Glasgow outcome score (GOS), computed tomography (CT), aetiology and outcomes and complications at discharge and during a 6-month follow-up were analysed. All patients underwent debridement. Intracranial haematoma evacuation, decompressive craniectomy (DC) or replacement were performed.

Results: Motor vehicle accident and struck by/against were the most common causes (43.2% each). At admission, 33 patients had Glasgow coma scores (GCS) > 8 and 27 of them had a GCS score of > 13. Mean follow-up was 8.7 ± 4.3 months. All patients underwent debridement, 20 underwent bone fracture replacement and 27 underwent haematoma evacuation; 11 patients underwent haematoma evacuation and DC and one had bilateral DC. Twenty-seven patients showed good recovery; 11 patients had moderate disability; three patients had severe disability; and three patients died. After 6 months, 32 patients had good recovery and the morbidity of severe disability had decreased to 13.6%. Thirteen patients developed intracranial infection. Post-traumatic epilepsy and hydrocephalus was detected in three patients. Cerebrospinal fluid fistula was found in five patients. Only one patient developed a brain abscess after 6 months.

Conclusions: NMOHI yielded satisfactory recovery and achieved good outcomes.

Keywords:

• Non-missile
• open head injury
• surgical management
• outcome

Declaration of interest

This work was supported by grants from the National Natural Science Foundation of China (No. 81070988, No. 81171166), and Science and Technology Committee of Shanghai (No. 0852nm04900, 11nm0503200). The authors report no conflicts of interest.