Open Head Injury

Open head injuries can be very scary and can sometimes appear worse than they actually are.  Since an open head injury refers to a trauma to the head where the skull gets punctured, not unlike any other puncture wound, the victim may be covered in blood and it may be difficult to locate the precise location of the wound.  Because the brain does not actually contain nerve receptors, other than due to the appearance of blood, a injured victim may not even realize they have suffered an open head brain injury.  You may have heard of the story of a Chinese man who didn't realize, for four years, he had a blade of a knife lodge in his head after a fight with a robber or a construction worker who went to the dentist complaining of a toothache only to learn that he had a 4-inch nail in is head.

Any number of accidents can result in an open head injury.   They can occur in car crashes, sports accidents, workplace accidents, or gunshot or knife wounds that create a skull fracture. Even objects like a screwdriver can pierce the skull and cause brain injury. If the object exits in a different location than where it entered, as in a gunshot wound, it’s known as a perforating open head injury.

When the skull is pierced, bone fragments from the skull may hit sensitive brain tissue and cause further damage. Also, because there’s an open wound, open head injury victims are prone to contamination or infection. Another possible result of an open head brain injury is intracranial hematoma or bleeding in brain.

In contrast, in a closed head injury, the skull isn’t broken. For a while, doctors assumed an open head wound would create a more serious brain injury than a closed head wound. However, they found that not to be the case. In a closed head injury, the damage creates pressure build up which can also damage the brain cells. Although the brain cells may be injured in an open head injury, because the skull is fractured, there’s less pressure on the brain, so no further damage to the brain cells is incurred beyond the initial wound.

Medical Treatment

As with all head injuries, it’s critical to get immediate medical treatment. If the open head injury victim gets an infection and it’s not treated, it can cause permanent brain damage or even death. Meningitis, an infection of the membranes surrounding the brain and spinal column, is the most typical infection following an open head injury. Antibiotics and medication to reduce brain swelling is the preferred treatment for this bacterial or viral infection.

Other possible open head injury complications may be:

  • Dementia
  • Paralysis
  • Seizures
  • Coma
  • Death

The first course of treatment for an open head injury victim is a visual assessment of injuries such as skull fracture and external bleeding. Doctors can also determine the extent of injury by measuring blood pressure, body temperature, breathing, and heart rate. They use MRI, CT, or ICP scans to assess the severity of internal damage.

In some cases, an open head injury victim will need surgery to repair a fractured skull and to stop the internal bleeding. The surgeon may need to remove bone fragments from the damaged skull which will reduce brain swelling. After surgery, doctors need to monitor possible complications like intracranial pressure or brain swelling. At some point, the patient may need additional surgery if pressure on the brain still needs to be reduced and blood that has collected beneath the skull needs to be drained.