# Primary Reconstruction of Extended Multifragmented Skull Fracture: Case Report and Technical Note

## TL;DR

A 59-year-old man with severe skull fractures was successfully treated with immediate reconstruction using his own bone, avoiding a more complex and costly procedure.

## Contribution

The paper highlights the benefits of immediate primary reconstruction using autologous bone in managing complex skull fractures.

## Key findings

- Immediate primary reconstruction using autologous bone avoided decompressive craniectomy.
- The patient recovered well without the need for additional surgical interventions.
- This approach reduces healthcare costs and complications.

## Abstract

Background and Clinical Significance: Traumatic brain injury (TBI) represents a major public health concern due to its profound neurological, psychological, and socioeconomic consequences. Effective management is essential to optimize patient outcomes and reduce healthcare burden. In cases involving extensive bone loss or complex fractures, particularly when decompressive craniectomy (DC) is considered, secondary cranial reconstruction is typically required. However, DC is associated with prolonged hospitalization, multiple surgical interventions, an increased risk of complications, and higher costs. Case Presentation: We present the case of a 59-year-old male involved in a high-energy bicycle accident, sustaining severe craniofacial trauma with multiple midface fractures, a multifragmented left cranial fracture, and a left-sided epidural hematoma with brain compression. Hematoma evacuation and immediate primary reconstruction of the fractured skull using autologous bone were successfully performed, avoiding the need for DC. The patient recovered under intensive care and was transferred to a neurorehabilitation center. Conclusions: Primary reconstruction of large skull fractures using autologous bone should remain the goal, whenever possible, in order to avoid additional costs, risks, and complications.