Contrecoup fractures of the anterior cranial fossae as a consequence of blunt force caused by a fall.

Contrecoup fractures of the base of the skull are regarded as rare in the clinical literature. In our material (n = 171 falls on the same level and on or from stairs), the overall frequency of contrecoup fractures of the anterior cranial fossa in fatal cranio-cerebral trauma due to falls was 12%, as compared to 24% with occipital point of impact of the head. The relationships between the impact site on the head, form of fracture at the point of impact with involvement of the skull cap and/or the base of the skull, coup and contrecoup injuries of the brain, localization of contrecoup fractures in the anterior cranial fossa and the occurrence of monocle and spectacle haematomas display a major variability. Fractures occur in the form of simple fractures and as impression fractures (fracture fragments or fracture boundaries displaced to the inside). Clinical diagnosis is difficult because of the concealed position of the anterior skull base. Contrecoup fractures become of forensic medical significance when symptoms of a frontobasal injury occur for the first time after trauma which has occurred some time in the past and when the question arises as to the causal connection with the original trauma. In investigation of living persons, it may be difficult to decide whether haemorrhages in the region of the orbit and its vicinity result from a direct blunt force or derive from fractures of the base of the skull, especially contrecoup fractures.