Spectrum of Computed Tomographic Findings Among Adults with Traumatic Skull Fractures in Ado-Ekiti

Background: Traumatic skull fractures are a common consequence of head injury and remain a major cause of morbidity and mortality, particularly in low- and middle-income countries where road traffic accidents are prevalent. Computed tomography (CT) is the imaging modality of choice for evaluating skull fractures and associated intracranial injuries. Objective: To determine the spectrum of CT findings and clinical outcomes among adults with traumatic skull fractures in Ado-Ekiti, Nigeria. Methods: This was a retrospective descriptive cross-sectional study of 117 adult patients with CT-confirmed traumatic skull fractures managed at a tertiary hospital in Ado-Ekiti over a period of 18 months from July 2024 to December 2025. Data were extracted from medical records and radiology reports using a structured proforma. Variables analyzed included socio-demographic characteristics, injury mechanisms, clinical presentation, CT findings, management, and outcomes. Data were analyzed using descriptive statistics and logistic regression to identify predictors of poor outcome. Results: The majority of patients were male (70.1%), with a predominance of young adults aged 18-39 years. Road traffic accidents (RTA) were the leading cause of injury (66.7%). Most patients presented with loss of consciousness (72.6%), and nearly half had mild traumatic brain injury (49.6%). CT findings showed that linear skull fractures (42.7%) were the most common, with the parietal bone (27.4%) most frequently involved. The most prevalent intracranial lesions were cerebral contusions (34.2%), brain edema (32.5%), and subdural hematoma (29.9%). Midline shift was observed in 21.4% of cases. Most patients (61.5%) were managed conservatively, while 38.5% underwent surgical intervention. At discharge, 55.5% achieved full recovery, whereas the mortality rate was 8.6%. Significant predictors of poor outcome included severe traumatic brain injury, midline shift, subdural hematoma, intensive care unit (ICU) admission, and age ≥ 60 years. Conclusion: Traumatic skull fractures in this setting predominantly affect young males and are mainly due to road traffic accidents. CT imaging reveals a wide spectrum of fracture patterns and intracranial injuries, which significantly influence patient outcomes. Early identification of high-risk features is essential to improve management and reduce mortality.