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• Stilettoed in the Sixties
  Eoghan P Ferrie
  Published on: 29 April 2016
• Recognising depressed skull fractures before CT scan
  Rachel C Hoey
  Published on: 29 April 2016

• Published on: 29 April 2016

  Stilettoed in the Sixties

  • Eoghan P Ferrie, Specialist Registrar Emergency Medicine
  • Other Contributors:
    • Ian Erskine FFAEM

  Dear Editor,

  One of the wonders of emergency medicine is that there are almost as many different causes of injury as there are injury types. It is therefore not surprising that there are a myriad of case reports in the literature describing unusual objects causing injury. However, some stories have already been told.

  I read the case report by Stables et al entitled “An unusual case of a compound depressed...

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  Dear Editor,

  One of the wonders of emergency medicine is that there are almost as many different causes of injury as there are injury types. It is therefore not surprising that there are a myriad of case reports in the literature describing unusual objects causing injury. However, some stories have already been told.

  I read the case report by Stables et al entitled “An unusual case of a compound depressed skull fracture after an assault with a stiletto heel” in the April 2005 issue of the Emergency Medicine Journal, and was struck with the thought that this must have been described before. How could we have come through “The Swinging 60’s” without this incident having occurred? Indeed, after a very brief search of “Google” using the keywords from the article ‘skull fracture ; stiletto heel’, the third result is of a case report in the British Medical Journal by Ahmed on “Stiletto Heel penetrating fractures of the skull” dated 1964.

  This highlights two important points. Firstly, it is important to remember that the regular Medline database only includes articles from 1966 to the present day, and it is necessary to search OldMedline for articles prior to 1966, or use Google as an obliging alternative.

  Secondly, don’t aggravate a girl with stiletto heels.

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  Conflict of Interest:
  None declared.

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• Published on: 29 April 2016

  Recognising depressed skull fractures before CT scan

  • Rachel C Hoey, A&E Consultant
  • Other Contributors:
    • David Gaunt and Petros Vlastarakos

  Dear Editor,

  We were interested in reading Stables et al.s’ account of a compound depressed skull fracture following an assault with a stiletto heal. They remind us to look thoroughly for a fracture in patients with scalp lacerations where the laceration was caused by some force. We recently had a similar case where a depressed skull fracture, under a laceration, was not found clinically. The fracture was seen on C...

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  Dear Editor,

  We were interested in reading Stables et al.s’ account of a compound depressed skull fracture following an assault with a stiletto heal. They remind us to look thoroughly for a fracture in patients with scalp lacerations where the laceration was caused by some force. We recently had a similar case where a depressed skull fracture, under a laceration, was not found clinically. The fracture was seen on CT scan, performed because the patient had a fit. The incident raised our awareness of the potential for an underlying fracture and may change our departmental practice.

  Stables et al comment on the guidelines published by The Society of British Neurological Surgeons in 1998 in which an indication for skull x- ray is a scalp laceration longer than 5 cm. They also mention that the depression is often not appreciated on x-ray, making the point about a need for careful examination of the wound, as the depression might not lie directly below the wound. This is obviously an important point, as this is how fractures can be missed in spite of wound exploration. In future cases in our department, we are likely to consider early CT imaging, as x-ray is unable to help diagnose brain injury.

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  Conflict of Interest:
  None declared.

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