Emergency Medicine

Identifying Fractures or Sutures in Pediatric Trauma Patients

October 13, 2021
EB Medicine

Skull sutures normally found in pediatric patients can make it difficult to differentiate a fracture from normal suture lines.⁷,⁹ CT with sagittal and coronal reformatted series as well as 3-dimensional shaded-surface volume-rendered images can accurately differentiate between fractures and sutures.⁹ Fractures have sharp borders and increase in diameter as they approach sutures. Fractures may cross sutures and can be associated with overlying soft-tissue swelling or hematomas and/or widening of the sutures (diastasis).⁹ In comparison, sutures are usually uniform in diameter, have a zigzag pattern with sclerotic borders, and join with (rather than cross) other sutures.⁹

Axial view (A, B, C) and 3-dimensional reconstructed (D, E) CT images of the head in a patient with a head injury. A mildly depressed fracture through the occiput is seen on the right (A, B, and D, black arrows) with associated mild soft-tissue swelling. There is also a nondepressed fracture through the left parietal bone, best seen on 3-dimensional reconstruction (E, red arrow). Diastasis of the lambdoid suture is also seen (C, green arrow). The fracture line is straight (E, red arrow; D, black arrow) as compared to the zigzag appearance of normal coronal and lambdoid sutures (D and E, blue arrows). Abbreviation: CT, computed tomography.
Images courtesy of Dr. Jinel Scott.

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Last Updated on October 27, 2021

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