Pediatric ping-pong skull fractures treated with vacuum-assisted elevation

Abstract

Abstract Purpose Depressed (“ping-pong”) skull fractures can be treated by different means and the outcomes for children treated with vacuum-assisted elevation are comparable to surgical treatment. Methods We present a retrospective review of all ping-pong skull fractures treated with vacuum-assisted elevation at Children’s Hospital of Orange County in 2021-22. Variables included patient age, mechanism of injury, fracture depth, bone thickness at fracture site, and degree of elevation. Results Seven patients underwent vacuum-assisted elevation of ping-pong fractures bedside without the use of anesthesia. Fractures caused by birth-related trauma were deeper than those caused by falls (p < .001). There was no difference between groups in bone thickness at the fracture site (2.10mm vs 2.16mm, n.s). Six of the seven patients experienced significant improvement in fracture site depression, with four displaying a complete fracture reduction and two displaying significant reduction. Degree of fracture reduction was modestly related to depth of fracture, with the two deepest fractures failing to achieve full reduction. Age appeared to be related to fracture reduction, with the lowest reduction observed in one of the oldest patients in this sample. No complications were observed in any patient other than temporary mild swelling at the suction site, and no re-treatment or surgery for the fractures was required. Conclusion Vacuum-assisted elevation of ping-pong skull fractures is a safe and effective treatment option for infants under certain circumstances and has many benefits. The procedure can be safely done at the bedside, avoids the need for open surgical intervention, anesthesia, or hospital admission, and is a relatively quick procedure.