Bone flap binding and transposition: a method for bone reconstruction in cranial burst fractures and early-stage growing skull fractures.

ABSTRACT

PURPOSE: To introduce a method of cranial bone reconstruction for cranial burst fractures and early-stage growing skull fractures, named bone flap binding and transposition. METHODS: Cranial burst fractures, severe head injuries predominantly observed in infants, are characterized by widely diastatic skull fractures coupled with acute extracranial cerebral herniation beneath an intact scalp through ruptured dura mater. These injuries can develop into growing skull fractures. This study included two cases to illustrate the procedure, with a particular focus on the bone steps in managing these conditions. The medical history, clinical presentation, surgical procedures, and postoperative follow-up were retrospectively studied. The details of the surgical procedure were described. RESULTS: The method of bone reconstruction, named bone flap binding and transposition, was applied after the lacerated dural repair. Two bone pieces were combined to eliminate the diastatic bone defect and then fixed by an absorbable cranial fixation clip and bound by sutures. The combined bone flap was repositioned into the bone window, completely covering the area of the original dural laceration. Subsequently, the bone defect was transferred to the area of normal dura. The postoperative courses for the two infants were uneventful. Follow-up CT scans revealed new bone formation at the previous bone defect and no progressive growing skull fracture. The major cranial defects had disappeared, leaving only small residual defects at the corners of the skull bone window, which required further recovery and did not affect the solidity of the skull. CONCLUSION: Bone flap binding and transposition provide a straightforward, cost-effective, and reliable method for cranial bone reconstruction of cranial burst fractures and early-stage growing skull fractures. This method has taken full advantage of the small infant's dura osteogenic potential without the need for artificial or metallic bone repair materials. The effectiveness of the method needs further validation with more cases in the future.