gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Bone defects in open depressed skull fractures – primary closure with bone cement (polymethylmetacrylate)?

Meeting Abstract

  • F. Bretschneider - Neurochirurgische Klinik, Zentralklinikum Augsburg
  • N. Rainov - Neurochirurgische Klinik, Zentralklinikum Augsburg
  • V. Heidecke - Neurochirurgische Klinik, Zentralklinikum Augsburg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP01-08

doi: 10.3205/09dgnc256, urn:nbn:de:0183-09dgnc2563

Published: May 20, 2009

© 2009 Bretschneider et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Surgery of open depressed skull fractures includes wound debridement, elevation of depressed bone fragments, removal of hematomas, and revision of contusions, dural, and vascular lacerations. If the impressed bone is crushed or strongly contaminated, in most cases wound closure is carried out in the first session, and the bony defect is covered in a secondary surgical procedure. The objective of this study was to analyze the results of primary closure of bone defects with bone cement (polymethylmetacrylate).

Methods: Data of patients who received polymethylmetacrylate during the primary operative procedure after open depressed skull fractures during a 22 year time period were collected retrospectively, and follow-up charts were reviewed.

Results: Among 352 cases with depressed skull fractures, there was a subgroup of 56 patients (29 females and 27 males) with open fractures and crushed bone fragments in whom it was impossible to close the defect with autologous bone fragments. The median age of the group was 33.5 years (range 2.3–-85.1y). The mean time interval between accident and surgery was 6 hours 34 minutes (range 1:15 – 19:50 hours). All patients received antibiotic treatment with a second generation cephalosporin or broad spectrum penicillin immediately before surgery. Two patients died a few days after the accident of unrelated causes, 30 patients were available for follow-up. The mean duration of follow-up was 42 months (range 3–228 months). There was one subgaleal fluid collection which resolved spontaneously. In one case with dislocation of the implant, a second procedure was performed to replace it. In one case there was delayed wound healing because of skin closure under tension. There were no wound infections and no adverse reactions to the implant. The cosmetic results were excellent.

Conclusions: Primary closure of bone defects with polymethylmetacrylate during initial surgery for open depressed skull fractures is safe and does not increase the risk of postoperative wound infection or bone infection in the investigated group of patients.