Which injury is characterized by a fractured skull?

• A. Closed head injury
• B. Penetrating brain injury
• C. Open traumatic brain injury
• D. Diffuse axonal injury

Answer: (C)

Fracturing the skull means the skull bone is breached, exposing the brain and its coverings. That situation fits open traumatic brain injury, where the skull and often the dura are breached and the brain is exposed to the external environment. Closed head injuries have an intact skull, so no fracture. Diffuse axonal injury involves widespread brain injury without necessarily a skull fracture, and penetrating brain injury is open but defined by a penetrating object entering the skull and brain. The skull fracture hallmark makes open traumatic brain injury the best description here.