Retrospective evaluation of the skull base fractures from the aspect of forensic medicine

There are very few studies about skull base fracture in the forensic literature. Our aim is to investigate the prevalence and pattern of skull base fracture and its association with death and intracranial injury. This study includes 1260 cases who were injured due to isolated head trauma during the 10-year period between 01.01.2010-30.11.2019. Our cases were divided into 2 groups as fatal head trauma (n=783) and non-fatal head trauma (n=477). All these cases were reviewed retrospectively in terms of age, gender, origin, cause of trauma, skull base fracture, skull vault fracture, facial bone fracture, intracranial injury, scalp injury and sub-scalp injury. Base fractures were observed in 87.5% of cases with fatal head trauma and in 32.3% of cases with non-fatal head trauma. The base fracture rate was significantly higher in the fatal group than in the non-fatal group (p<0.001). While isolated anterior fossa, isolated middle fossa and isolated posterior fossa fracture rates were found to be significantly higher in the non-fatal group than in the fatal group; the rate of combined anterior and middle fossa fractures and the rate of combined anterior, middle and posterior fossa fractures were found to be significantly higher in the fatal group than in the non-fatal group (p<0.05). The middle fossa was fractured more than the anterior and posterior fossa in both groups. Skull base fracture was strongly associated with death (OR: 15.253). The rate of intracranial injury was found to be significantly higher in cases with base fractures than those without (p<0.001). In conclusion, in our study, it was observed that skull base fracture was quite frequently associated with especially fatal head traumas and this fracture was strongly associated with death. In the antemortem and postmortem examination of cases injured due to head trauma, skull base fracture should be investigated with high care. In cases with fractures, a detailed examination should be performed in terms of the size and type of the fracture and intracranial lesions that may be associated with the fracture. Key words: Skull base fracture, fatal, non-fatal, forensic medicine