Surgical management and outcome of depressed skull fractures at Niamey National Hospital: About 233 cases

Background: Depressed skull fractures constitute a common trauma condition in neurosurgery. Their surgical aspects and outcome remain less studied at Niamey. Objective: To study the surgical aspects and describe the outcome of surgical depressed skull fractures at Niamey National Hospital in Niger republic. Method: This is a three years retro and prospective study from January 1st, 2020 to December 31st, 2022 run at National Hospital of Niamey in Niger republic. Results: A total of 233 patients were included of which, 202 men (86.7 %) and 31 females (13,3%) with a sexratio of 6.51. Road traffic accident was the common cause (n = 141; 60.5 %) followed by assault (n = 43; 18.5 %) and fall (n = 27; 11.6 %). Patients from urban area were predominant (n = 161; 69.1 %). Head CT Scan constituted the most common diagnosis tool. Considering the type of depressed fractures, greenstick depressed fractures were the most frequent (n = 139; 59.7 %) followed by comminuted ones (n = 70; 30 %). Ping-pond fractures accounted for 24 cases (10.3 %) and were only seen in children. About the type of associated injury, cranio-cerebral wound (n = 73; 31,3%), extradural hematoma (n = 31; 13.3 %), and cerebral contusion (n = 10; 4.3 %) were commonly seen. Most of the patients had mild head trauma (n = 194; 83.3 %). Craniotomy with bone fragment replacement was commonly performed (n = 102; 43.8 %) followed by simple fracture elevation in 42.5 % (n = 99;). Most of the patients experienced an uneventful outcome (n = 227; 97.4 %). The death rate was very low (0.9 %; n = 2). Conclusion: Depressed skull fractures constitute a common traumatic neurosurgical pathologies met at Niamey National Hospital. CT Scan constitutes the main diagnosis tool. Its treatment is often surgical.