FIGURE 113.3 Linear skull fracture An axial CT scan with bone windows demonstrates a closed linear nondisplaced skull fracture through the left orbital roof Current Evidence Unilateral, linear skull fractures account for approximately 75% of pediatric skull fractures ( Fig 113.3 ) This estimate applies to both accidental and nonaccidental pediatric skull fractures The incidence of underlying intracranial injury ranges from 15% to 30% Complicated skull fractures may include fractures that cross suture lines, complex, burst, depressed, diastatic, bilateral, multiple, or open fractures Figure 113.4 shows a closed, depressed skull fracture Complicated fractures have, not only an increased likelihood of underlying intracranial injury, but also an increased association with nonaccidental trauma Of the complex fractures, ones that