Boulder fracture: symptoms, risks, what is it?

The petrous bone is a cranial bone that is part of the temporal bone. Depending on the case, the fracture of the rock can be perfectly benign, or more serious, either due to damage to the inner ear or due to the occurrence of other brain lesions. How does it arise? What are the treatments ? Answers from Prof. Marc Guénot.

What is a rock fracture?

The rock is a pyramid shaped piece of bone, located at the base of the temporal bone. It is crossed by the facial nerve. His fracture is often the result of a violent shock to the skull : road or sports accident, violent blow… It can be mild and require no treatment other than monitoring, but it can also be very severe and affect neighboring organs : the meninges, which surround the brain, and line the inside of the cranial box, but also the inner ear, the eardrum, the auditory and facial nerves. In case of head trauma, this fracture should always be sought.

What is a longitudinal rock fracture?

We are talking about a longitudinal rock fracturee when it is parallel to the axis of the rock.

Diagram (drafting)

What are the symptoms ?

If she is benignit may not cause no symptoms. “But if it is more serious, it can lead to bleeding (flow of blood from the ear), a otorrhea (i.e. cerebrospinal fluid leaking from the eardrum if the latter was also torn by the trauma), or, more simply, dizzinessof the tinnitusof the balance disorders and vomitingexplains Prof. Guénot. A deafnessa facial paralysis are other symptoms of this impairment. Sometimes, following the shock, the fracture of the rock is associated with post-traumatic lesions of the brain itself which can cause other symptoms, going as far as coma short or long term”.

What imagery reveals a rock fracture?

A to scan reveals a rock fracture.

What are the sequelae after a rock fracture?

In 24 to 81% of casesthe fracture of the rock results in a deafnessmore or less complete, and a facial paralysis in 7 to 30% of cases. In all cases, an ENT assessment is required.

In 24 to 81% of cases, the fracture of the rock leads to deafness

What antibiotic therapy in case of fracture of the rock?

“Generally, a rock fracture does not require specific treatment, says Prof. Guénot. But, in certain cases (osteo-meningeal breach in particular), to prevent meningitis, antibiotic therapy can be discussed. This antibiotic therapy is often not necessary in the end, because the osteo-meningeal breaches usually close spontaneously quite quickly.“.

Can rock fracture cause meningitis?

The fracture of the rock, no, but a violent shock, responsible for the fracture, can also cause a breach to the meninges (called osteomeningeal breach), through which cerebrospinal fluid can flow. That increases the risk of contracting meningitis.

Is she deadly?

“Not in itself. One does not die from a fracture of the rock, however, depending on the importance of the shock to the head and the brain damage caused, the vital prognosis can be engaged“, explains Pr. Guénot.

Thanks to Pr Marc Guénot, head of the Functional Neurosurgery Department, P. Wertheimer Neurological Hospital in Lyon.

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