Fatal tetanus complicating an untreated mild open head injury: a case-illustrated review of cephalic tetanus.

BACKGROUND: Tetanus is now a rare disease in the Western world, but not so in developing countries. Cephalic tetanus, unlike some other local forms of the disease, is likely to be fatal. METHODS: We describe the clinical presentation of a case of fatal cephalic tetanus complicating an unattended open non-severe head injury with a review of the literature on the disease. RESULTS: Few cases of cephalic tetanus complicating head injury are found in the world literature, and many were diagnosed late. Cephalic tetanus from open or compound depressed skull fracture is even more rare. Our patient was a young male with an uncertain tetanus immunization history who sustained mild head injury (scalp laceration) and an unattended open depressed skull fracture in a motorcycle crash. He developed cephalic tetanus seven days later, presented late to our service, and died while being prepared for surgical debridement of his cranial wounds. At the immediate post-trauma medical contact, in an across-the-street "clinic," he had received suboptimal care for his head wound and inadequate tetanus prophylaxis. CONCLUSION: Cephalic tetanus is a rare form of the disease. Although it is preventable easily by well-established medical and surgical treatment paradigms, it continues to catch many clinicians disastrously unaware.

Infection in compound depressed fracture of the skull.

OBJECTIVE: To find out the association of wound infection with dural tear, free bone fragments and late presentation in patients operated for compound depressed fracture of the skull. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: This study was conducted in the Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad from January 2002 to December 2002. SUBJECTS AND METHODS: There were 56 patients with compound depressed fracture of the skull, who were operated in the department. Their clinical, radiological and operative findings were studied. The postoperative condition of the wound was noted. The patients were followed up for six months. All of them were given antibiotics. The mode of trauma, time of arrival and site of fracture were noted. The mean age, male to female ratio and rate of postoperative wound infection were determined. RESULTS: Among the 56 patients operated for compound depressed fracture, there were 30 adults and 26 children. Male to female ratio was 4.6:1. Mean age was 21.7 years. Major mode of trauma in children was fall, while most of the adult patients presented with history of assault and RTA. There were 71.42% fractures in frontal and parietal regions. Three patients (5.35%) got wound infection postoperatively. CONCLUSION: Dural tear, free bone fragments and late presentation (more than 8 hours after trauma) were the important risk factors. Early surgery and proper debridement with antibiotic cover play an important role in reducing the rate of wound infection.