Which skull fracture occurs at the base of the skull and may leak cerebrospinal fluid from the nose or ears?

• A. Linear fracture
• B. Depressed fracture
• C. Skull fracture
• D. Basal skull fracture

Answer: (D)

A fracture at the base of the skull is a basilar (basal) skull fracture, and it has a characteristic risk of cerebrospinal fluid leaking from the nose or ears. When the skull base is injured, the dura can tear and CSF can escape into the nasal passages or middle ear, so clear drainage or a salty taste from the nose or ears may be seen. This type of fracture often accompanies other signs of serious head injury, such as bruising around the eyes or behind the ears, and it carries a risk of meningitis if the leak persists. In the field, recognizing CSF leakage from the nose or ears means you’re dealing with a skull base injury, so protect the airway without inserting nasal devices, stabilize the neck, and transport promptly for definitive care. The other fracture types describe fractures of different skull regions (a linear fracture is a simple line, a depressed fracture involves inward compression of a skull bone, and a generic skull fracture isn’t specific to the base). The presence of CSF leaking from the nose or ears is the key indicator pointing to a basal skull fracture.