• Handren Muhamad Rasheed Neurosurgery Department, Shar Teaching Hospital, Sulaimani, Kurdistan Region, Iraq.
  • Pakhshan Mohammed Faraj Community Health Department, Sulaimani Polytechnic University, Kurdistan Region, Iraq.



Depressed skull fracture (DSF), Head injury, Head trauma, Infection, Surgical site infection (SSI)



Infection can occur after compound depressed skull fracture (DSF) if not timely treated.


To assess the time effect from accident to surgical intervention on surgical site infection (SSI).

Patients and Methods

A retrospective cohort study was performed on 63 patients admitted to Shar Hospital from September 1, 2020, to May 13, 2021. Demographic features, type of trauma, time from accident to intervention, Glasgow Coma Scale (GCS), DSF location, associated brain injuries, dural tear, and admission to intensive trauma care unit (ITCU) were recorded. Patients followed up for 30 days.


Mean±SD (standard deviation) of ages was 23.8±18.1 years, ranging from 1-70. The male-to-female ratio was (4.25:1), and patient majorities (46% and 87.3%) were workers outside the city, respectively. Patients’ ages, occupations, and residencies were significantly associated with SSI; p-values of <0.001, <0.001, and 0.004, respectively. 4.8% of patients were afflicted with SSI. Associations of admission GCS and DSF location with SSI were significant. Surgery was done for most patients (52.4%) within six hours, but the association of time from accident to surgery was non-significant. Mean±SD duration from accident to surgery was 8.1±5.1 hours, ranging from 1.5-29. All afflicted patients with SSI had basal skull fracture (BSF) and aerocele. The dural tear did not associate with SSI. All afflicted patients who underwent frontal sinus cranialization were admitted to the ITCU and significantly associated with SSI. 


There was no significant association between SSI occurrence and the time from the accident until surgical intervention.


Ali M, Ali L RI. Surgical Management of Depressed Skull Fracture. Pak J Med Sci. 2011;17(1):116-23.

Yuan Q, Liu H, Wu X, Sun Y, Yao H, Zhou L, et al. Characteristics of acute treatment costs of traumatic brain injury in Eastern China - A multi-centre prospective observational study. Injury. 2012;43(12):2094–9. DOI:

Pérez K, Novoa AM, Santamariña-Rubio E, Narvaez Y, Arrufat V, Borrell C, et al. Incidence trends of traumatic spinal cord injury and traumatic brain injury in Spain, 2000-2009. Accid Anal Prev. 2012;46:37–44. DOI:

Foreman PM, Harrigan MR. Blunt Traumatic Extracranial Cerebrovascular Injury and Ischemic Stroke. Cerebrovasc Dis Extra. 2017;7(1):72–83. DOI:

Rolekar N. Prospective study of the outcome of depressed skull fracture and its management. Int J Med Sci Public Heal. 2014;3(12):1540–4. DOI:

Ahmad S, Afzal A, Rehman L, Javed F. Impact of depressed skull fracture surgery on outcome of head injury patients. Pak J Med Sci. 2018;34(1):130–4. DOI:

Garner BH, Anderson DJ. Surgical Site Infections: An Update. Infect Dis Clin North Am. 2016;30(4):909–29. DOI:

Panel N, Lefebvre JL, Cazin JL, Clisant S, Neu JC, Dervaux B, et al. Additional direct medical costs associated with nosocomial infections after head and neck cancer surgery: a hospital-perspective analysis. Int J Clin Oral Maxillofac Surg. 2008;37(2):135–9. DOI:

O'Keeffe AB, Lawrence T, Bojanic S. Oxford craniotomy infections database: A cost analysis of craniotomy infection. Br J Neurosurg. 2012;26(2):265–9. DOI:

Broex ECJ, van Asselt ADI, Bruggeman CA, van Tiel FH. Surgical site infections: how high are the costs? J Hosp Infect. 2009;72(3):193–201. DOI:

Alfonso JL, Pereperez SB, Canoves JM, Martinez MM, Martinez IM, Martin-Moreno JM. Do we see the total costs of surgical site infections? A Spanish study. Wound Repair Regen. 2007;15(4):474–81. DOI:

Coello R, Charlett A, Wilson J, Ward V, Pearson A, Borriello P. Adverse impact of surgical site infections in English hospitals. J Hosp Infect. 2005;60(2):93–103. DOI:

Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24–33. DOI:

Nobile M, Navone P, Orzella A, Colciago R, Auxilia F, Calori G. Developing a model for analysis the extra costs associated with surgical site infections (SSIs): an orthopaedic and traumatological study run by the Gaetano Pini Orthopaedic Institute. Antimicrob Resist Infect Control. 2015;4(S1):2015. DOI:

Oktay K, Guzel E, Unal E, Yilmaz T, Okten AI, Guzel A. Outcome of Primary Bone Fragment Replacement in Pediatric Patients with Depressed Skull Fracture. Pediatr Neurosurg. 2019;54(1):28–35. DOI:

KC B, Shakya B, Thapa A. Study of the outcome of patients sustaining depressed skull fracture following blunt head trauma. J Coll Med Sci-Nepal. 2018;14(2):81–4. DOI:

Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of depressed cranial fractures. Neurosurgery. 2006;58(3 Suppl):56–60. DOI:

Mukherjee KK, Dhandapani S, Sarda AC, Tripathi M, Salunke P, Srinivasan A, et al. Prospective comparison of simple suturing and elevation debridement in compound depressed fractures with no significant mass effect. Acta Neurochir. 2015;157(2):305–9. DOI:

Al-Haddad SA, Kirollos R. A 5-year study of the outcome of surgically treated depressed skull fractures. Ann R Coll Surg Engl. 2002;84(3):196–200.

Hossain MZ, Mondle M, Hoque MM. Depressed Skull Fracture: Outcome of Surgical Treatment. J Teach Assoc. 2008;21(2):140–6. DOI:



How to Cite

Rasheed H, Faraj P. COMPOUND DEPRESSED SKULL FRACTURE, ITS ASSOCIATION WITH INFECTION, AND IMPORTANCE OF THE TIME FROM THE ACCIDENT. JSMC [Internet]. 2022 Sep. 21 [cited 2024 Apr. 23];12(3):281-8. Available from:

Similar Articles

1-10 of 152

You may also start an advanced similarity search for this article.