A blunt object, which causes a large depressed fracture in an adult, causes a ping–pong ball fracture in a child, whose skull is soft and dents instead of fracturing. The indications for not operating on a child are even stronger than in an adult, because these fractures rarely cause trouble. If a child has a single fit, disregard it. The dent will disappear as he grows.
ELEVATING A PING PONG–BALL FRACTURE If you decide to raise the fracture, try first with a vacuum extractor. Apply one of the vacuum cups, as you would during delivery. Pull, and hold the surrounding skull with your other hand. If this fails, make a hole with a perforator at the edge of the depression and elevate the fracture with a skull elevator, as in Fig. 63-16. Make the hole for it with a perforator and nibblers and don’t use burrs.