Which of the following is NOT a common sign of a skull fracture?

• A. Deformity of the skull
• B. Battle's sign
• C. Superficial scalp lacerations
• D. Raccoon eyes

Answer: (C)

When assessing a head injury, signs that point to a skull fracture are direct clues about the skull itself. Deformity of the skull clearly indicates a disruption of the skull’s integrity. Battle’s sign—bruising behind the ear—and raccoon eyes—periorbital bruising—are classic indicators of basilar skull fracture, reflecting bleeding and injury at the base of the skull. These signs arise from the fracture and underlying damage, so they strongly suggest a skull fracture.

Superficial scalp lacerations, on the other hand, are soft-tissue injuries. They can occur with head trauma regardless of whether the skull is fractured and do not reliably indicate a fracture. A patient may have a skull fracture with little or no scalp wound, or a scalp wound without a fracture. That’s why this option is not a common sign of a skull fracture.

So, the best answer is the feature that doesn’t reliably signal a skull fracture: a superficial scalp laceration.