There have been limited reports on
machete wounds to the cranium. This study was carried out to document the injury profile in a series of patients who have sustained cranial
injuries from
machete wounds in this setting. Between 1 January 1998 and 1 January 2008, demographic and clinical data were retrospectively collected from all patients treated with complicated
head injuries from
machete wounds with at least one of the following clinical or radiological features: a recorded Glasgow
Coma Score < 8 at any point during admission; compound
skull fractures; protruding brain matter; cerebrospinal fluid (CSF) leaks; intra-cranial
bleeding; parenchymal
contusions;
lacerations and/or oedema. The data were analysed using the SPSS version 12.0. Of the 40 patients with complex
injuries to the cranium, there was a 6:1 male preponderance with a mean age of 32.5 ± 13.7 years (Mean ± SD). The
injuries included open
skull fractures in all the 40 (100%) patients,
depressed skull fractures in 20 (50%) patients, CSF leaks in 4 (10%) patients, protruding brain matter in 4 (10%) patients,
cerebral contusions in 3 (7.5%) patients and extra cranial
injuries in 16 (40%) patients.
Tetanus prophylaxis and intravenous
antibiotics were administered to all patients, and
phenytoin was required in 16 (40%) cases. There were 37 (92%) patients requiring operative intervention at a mean of 10.4 h after presentation (SD ± 18.1; Median 6). The operative procedures included elevation of depressed fractures in 20 (54.1%) patients, dural repair in 10 (27.0%) patients and intra-cranial
debridement in 7 (18.9%) patients. There were three deaths (7.5%), and
seizures were recorded in 5 (12.5%) cases with no reports of infectious morbidity. Eighty percent of patients had a normal Glasgow outcome score on discharge. Complicated
machete head trauma is uncommon at this health care facility in Jamaica. We achieved a satisfactory outcome with aggressive management consisting of prompt assessment of the extent of injury, appropriate
antibiotics,
anticonvulsants for those with
seizures or cortical injury and early operation to decrease the risk of complications.