Tangential views or computed tomography in suspected depressed skull fracture

February 6, 2001

July 9, 2002

Magnus Harrison, Specialist Registrar (Manchester Royal Infirmary)

Steve Jones, Manchester Royal Infirmary

In [patients presenting with head injury and suspicion of depressed skull fracture] is [tangential x-ray or CT scan better] at [detecting depressed skull fracture]?

A 35-year-old man alleges that he has been assaulted. He claims that he was hit on the head with a hammer. He is only complaining of pain around the site of the injury. On examination there is haematoma present, but no laceration. Standard skull views reveal no bony injury. You suspect a depressed skull fracture and wonder whether a tangential x-ray of the site of the injury, or a CT scan would be better able to detect it.

Medline 1966-04/02 using the OVID interface.

[exp skull fractures OR exp skull fracture, depressed OR ({skull.mp OR cranium.mp OR calvarium.mp} AND {fracture.mp AND depressed.mp})] AND [exp x-rays OR x-rays.mp OR roentgenogram.mp OR tangential.mp OR oblique.mp] AND [exp tomography, x-ray computed OR ct.mp OR tomography.mp OR ct scan$.mp] LIMIT to human AND English.

No papers were found that addressed the three-part question.

Intuitively it would seem that CT scan is the best method available to investigate such injuries. However, there is no evidence to show that it is better than tangential skull views.

Local neurosurgical advice should be followed.