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Fig. 116.—Depressed comminuted fracture of
skull caused by a blunt weapon.

If not associated with an external wound fracture of the vault is not
always easily diagnosed. In such cases it is best to rely on the general
symptoms resulting from injury to the meningeal vessels, cerebral sinuses
and brain. -

Fractures of the vault, though dangerous, do not always end in death.
I have seen cases in which recovery occurred after the vault of the skull
was fractured.

A boy, ten years old, was hit on the
head with a lathi and sustained a
lacerated wound, 3" by i", along the
right side of the crown of the head
with a fissured fracture of the right
parietal and occipital bones and partial
paralysis of the left upper limb. After
nine days he was admitted into the
King George's Hospital, Lucknow, and
was discharged cured after three
weeks. Dawson3 relates the case of
a girl, about 8 years old, who was
knocked down by a motor lorry and
sustained fractures of the parietal,
temporal and frontal bones with frac-
ture extending into the base of the
skull. At the operation it was found
that the dura mater was torn through
which the brain matter was escaping.
The patient recovered in a month's
time. Tichborne4 also relates the
case of a woman who was brutally assaulted by her husband, and who received five
wounds on the head with complete compound fractures of the vault of the skull.
The fractures were situated on the left temporal, frontal, right and left parietal, and
occipital bones, the fracture on the occipital bone being 5" long and 1J-" gaping. All
these fractures communicated with the surface of the brain, and in all cases the cerebral
meninges were exposed. After three days she was taken to hospital, where the severed
muscles and the torn scalp seemed sloughing and a general septic state prevailed. The
patient did live and attended the court three months later.

The Base of the SkuilL—Frac-
ture of the base of the skull is
generally caused by a blow or fall
upon the vertex as the head is
pressed on the other side of the
spinal column. It may be caused
"by a direct blow from the point of
an umbrella or stick thrust
through the roof of the orbit or up
the nose through the cribriform
plate, by a violent blow on the
chin or by a gunshot wound
through the roof of the mouth. It
may also result from extension of
a fracture of the vault, or may be
caused indirectly by a heavy fall
upon the feet or nates.

The symptoms observed in fractures of the base are—

(1)   Signs of concussion or compression of the brain.

(2)   Effusion of blood in the subconjunctival tissue,  or  in the  sub-
occipital and mastoid regions.

Fig. 117.—Fractures of skull caused by
a banka  (cutting weapon).

3.   Ind. M«L Gaz., Feb. 1926, p. 65.

4.   Lancet, Sept. 22, 1928, p. 599.