Split Calvarial Graft Reconstruction for Growing Skull Fracture in Pediatrics

Abstract
Background: Growing skull fracture is a rare but well-known complication of skull fracture in infancy and early childhood. The definitive treatment is Duro-cranioplasty. The use of alloplastic material in cranial reconstruction has been well described in adult but in children it is hesitation about the safety of nonexpansible alloplastic material.
Aim of Study: This is a retrospective study to evaluate autologous split thickness skull grafts and cranioplasty for treatment of growing skull fractures in pediatrics.
Patients and Methods: This is a retrospective study of complicated calvarial fractures presented at Mansoura Uni-versity Hospital from 2015 to 2018 and included 10 patients with growing skull fractures. All patients underwent autologous cranioplasty of the skull defect secondary to growing skull fracture after duroplasty.
Results: The age at injury ranged from 5M-6 years. The cause of these fractures included falls and vehicle accident. On average, progressive swelling was diagnosed 7 months after the initial injury. The size of the cranial defects was average 3 X 3cm after restoration of dural contour (duroplasty). Six patients (60%) needed blood transfusion. Follow-up for patients was an average of 6 months. All patients showed post-operative bone fusion without evidence of complications.
Conclusion: The concern for growth restriction or implant instability in a growing pediatric skull also the cost, limit the use of alloplastic materials. Our data show that autologous bone grafting is the standard in pediatric population regarding the safety and cost with limited post-operative complications. Moreover, early recognition is crucial in the management of GSFs to avoid the progression of neurological consequences and skull deformities.