Pediatric Skull Fracture

At my institution, the majority of residents and attendings use 3D reconstruction on all pediatric head CTs. As you can see, finding a fracture can be difficult with the unfused head sutures. When the fracture line is parallel with the axial head CT slice, it is almost impossible. Use of an anatomy reference to identify normal sutures is essential for the radiologist in training (i.e. Netter F. Atlas of Human Anatomy 3rd ed, Plate 11). In pediatric and adult head CTs, you can use scalp hematomas and/or abrasions to help localize intracranial/cranial findings.

The presence of a fracture of the skull alone without associated clinical abnormalities of the sensorium or the central nervous system is of little significance. The presence of a fracture should not alter the decision for future medical care except in children with a depressed or compound fracture.

Reference:
Harwood-Nash, DC. "The Significance of Skull Fractures in Children, A Study of 1,187 Patients". October 1971 Radiology, 101, 151-155.