Use of a percutaneous bone fiducial screw for elevating simple closed depressed skull fractures: illustrative cases

BACKGROUND Depressed skull fractures in infants often present as “ping-pong ball” fractures with inward buckling of the calvarium, secondary to trauma. Management varies widely, and few concrete guidelines exist in the literature to guide decision-making when choosing a methodology for fracture elevation. The authors present two cases of attempted depressed skull fracture elevation with traction on a percutaneously placed bone fiducial screw, followed by a review of the literature, in order to further investigate the factors considered when selecting an intervention. OBSERVATIONS An 8-month-old female and a 10-month-old male presented with a right parietal depressed skull fracture. Both underwent attempted fracture elevation with a self-tapping screw anchored into the skull. The authors directly elevated the fracture with the screw technique in the 8-month-old female patient. The 10-month-old male had persistent depressed skull deformity; thus, the authors extended the incision for a standard craniotomy for depressed skull fracture elevation. LESSONS Percutaneous screw placement may be considered an option in the spectrum of treatment strategies for select patients with depressed skull fractures. Consideration of patient age, skull thickness, and depth of skull fracture can assist with the choice of treatment strategy and the preoperative prediction of the likelihood of fracture elevation success with this technique.