Skull fracture vs. accessory sutures: how can we tell the difference?

Excerpt

Plain film radiography remains the most cost effective method in evaluating skull fractures and can easily differentiate major sutures and common vascular grooves from fractures. However, in children this can be complicated due to the presence of numerous synchondroses and unusual accessory sutures. Plain film evaluation is especially challenging not only because of various artifacts that can degrade the study but also the inability to visualize intracranial processes, such as contusions and hemorrhage, that can substantiate a calvarial finding. Minimal soft tissue swelling can be difficult to see even with oblique views. Superimposition of normal suture lines like the metopic suture can mimic a fracture if one is not careful to obtain additional views [1]. During the past decade, the increasing use of spiral and multidetector CT have lead to the ability of workstations to generate three-dimensional (3D) reconstructions of the skull. Therefore if cranial CT is deemed clinically necessary in trauma patients, questionable fractures can be confidently differentiated from unusual accessory sutures using these additional workstation capabilities. …