Head / Spine / Chest Fractures

Facial, axial and chest-wall fractures — presentation and initial management. For head-injury imaging decisions, see Head Injury & Concussion; for spinal-column injury classification (including sacrum/coccyx, moved there 2026-08-25), see Back: Acute Spinal Injuries.

Skull fracture

Closed fractures with no neurological compromise do not need intervention. A depressed fracture may need surgical elevation of the segment. Care if the fracture crosses the midline — risk of sagittal sinus rupture and profuse bleeding with minor fragment movement.

Base of skull fracture

Suspect with bleeding from the nose/throat/ears, raccoon eyes or Battle sign; CSF may leak from the nose. Management is conservative — monitor for infection/meningitis.

Malar (zygomaticomaxillary) fracture

Commonly from contact sports or a punch. Check for ocular trauma and diplopia (extraocular muscle entrapment) — facial CT + orbits for a blow-out fracture. Advise against nose-blowing. May need surgery.

Mandibular fracture

Usually follows punching trauma. Look for sub-mucosal ecchymosis. Office test: bite on a tongue depressor and twist — pain on twisting suggests fracture. Immobilise in a four-tailed bandage; refer for review and possible fixation.

Dislocated jaw

Jaw locked open, unable to close the mouth or speak clearly. Reduction: thumbs on the lower molars, pull downward while fingers on the mandibular angle guide the jaw back.

Rib fractures

Pain at the fracture site on palpation, deep breathing and coughing — pneumonia risk from atelectasis (encourage deep breathing/analgesia). X-ray is often negative for the fracture itself but should still be done to look for associated pneumothorax or haemothorax. Lower rib fractures raise suspicion of splenic, hepatic or renal injury. Healing: 3–6 weeks.

Sternal fracture

Associated with intrathoracic injury — myocardial contusion, pericardial tamponade. Evaluate in the emergency department; obtain an ECG.