Percutaneous microscrew elevation of Ping-Pong skull fracture in a child-technical note

Abstract Introduction In neonates, depressed skull fractures are sometimes colloquially referred to as "ping-pong fractures" or “ pond-fractures” due to their appearance on imaging. These fractures typically occur as a result of relatively low-force trauma, Cosmetic concern is one of the indications of surgical intervention. Case presentation We received a seven-month-old female child, with alleged history of fall from her mother’s lap. On arrival child was conscious, active and alert. On palpation, there was a significant depression in the skull at the site of impact. CT scan showed ping-pong fracture of right parietal eminence. Operative technique We performed the procedure in OR under local anesthesia. The area of screw insertion was infiltrated with 1% lidocaine. We inserted two 5-mm self-tapping microscrews supposed to be used for cranial plating (Medtronic) percutaneously into the depressed fragment. With the help of Kellys’ clamp, traction was applied which elevated the fractured segment with an audible ‘pop’. Postoperative period was uneventful. A postoperative CT scan demonstrated adequate elevation of the fracture. Conclusion This technique is simple, safe, and inexpensive and the hospital stay is short.