Ping-pong skull fractures – the patterns and management: a retrospective cohort study at a pediatric neurosurgery center

Introduction: A ping-pong fracture is a type of depressed skull fracture seen in neonates and children typically occurring due to trauma. Most of the literature on this topic is limited to case reports. We aimed to identify the pattern of fractures and associated surgical management of such fractures.

Methods: A retrospective analysis of our hospital data was conducted and included all the children ( < 16 years of age) who were admitted with a ping-pong fracture between 2010 and 2020. Demographic data, clinical presentation, radiological findings, and treatment methods were collated. We analyzed the data to highlight any trends in the pattern of injuries and their relationship with the management decision.

Results: 21 patients were identified. 40% of patients sustained the fracture due to childbirth trauma. 15 patients had sustained a parietal bone fracture, 5 patients sustained a frontal bone fracture, and 1 patient sustained an occipital bone fracture. The mean depth of the fracture was 5.7 mm with standard deviation of 2.7mm across the cohort of patients. 52% of patients were conservatively managed and surgical elevation was performed for the remaining. In the surgically treated group of patients the mean depth of fracture was 7.1mm with a standard deviation of 2.9mm. In the conservatively managed group, the mean depth of fracture was 4.5mm with a standard deviation of 1.6mm.

Conclusion : Ping-pong fractures can occur at any age, often after direct trauma. Most are not associated with seizures or neurological deficits. CT scan was performed for all patients. Surgical intervention was needed for deep fractures.