The traditional method is to remove the fragmented bone and apply synthetic material for future skull repair or second-stage implantation of skull fragments, which is painful for patients and costly for medical treatment. From January 1998 to September 2006, 32 cases of depressed comminuted fractures of the skull were treated surgically in our hospital. The intraoperative application of cranial lock (produced by Shanghai Bona Company) combined with EC glue (produced by Guangzhou Baiyun Medical Corporation) in the first stage of cranioplasty obtained good results, which are reported as follows. Clinical data 1. General data Inclusion criteria: all patients with skull depression comminuted fracture were admitted to hospital within 24 h after injury. Among the 32 cases in this group, 24 were male and 8 were female; age ranged from 7 to 56 years. Reasons for injury: 18 cases of car accident injury, 6 cases of fall injury, and 8 cases of blunt force trauma. Injury site: 18 cases of frontal, 4 cases of top, 2 cases of temporal, 4 cases of frontotemporal, and 4 cases of top of frontal. There were 18 closed cases and 14 open cases. There were 22 cases with 3-5 fracture fragments and 10 cases with more than 5 fragments. The range of depression fracture was 3 cm×4 cm～6 cm×8 cm; depression depth >1 cm in 24 cases, depression depth <1 cm in 8 cases. 2 cases were combined with epilepsy, 6 cases were combined with hemiparesis. There were 16 cases of combined epidural hematoma, 24 cases of combined dural rupture, 12 cases of combined cerebral contusion and subdural hematoma, and 4 cases of combined cerebral contusion and intracerebral hematoma. All the above cases were diagnosed by cranial CT and X-ray examination before surgery. For closed depressed comminuted fractures, the depressed comminuted bone fragments were directly repaired, and the free fragments were repositioned in situ one by one with EC glue to form complete bone flaps wrapped in wet gauze. For open depressed comminuted fractures, the removal of skull fragments should be done in such a way that the rough surface and irregular shape of the skull defect edges are preserved, and bone wax is not used to stop bleeding as much as possible [1]. After the removed skull fragments were rinsed with saline, they were soaked in 3% hydrogen peroxide and 0.2% metronidazole solution for 5-10 min, and finally soaked in 1:1000 ml gentamicin saline solution for 30 min. If the wound was heavily contaminated, the skull fragments were treated with the above method, and then the fragments were soaked in 75% alcohol solution for 30 min and rinsed with saline. The deactivated plate barrier around the fragmented bone was removed by biting forceps to make the plate barrier around the skull fragment fresh. Then, several holes were drilled or sawed on the larger fragmented bone pieces to the depth of the lamina cribrosa. The free bone fragments are repositioned in situ one by one with EC glue to form a complete bone flap, and the small bone fragments are used for bacterial culture and drug sensitivity test. The repaired bone flap was repositioned (the larger bone fragments were repositioned according to the fracture line, and the remaining small fragmented bone fragments were placed between the bone fragments, and only the inner plate was implanted if the inner and outer plates were separated, and the fragmented bone fragments were placed close together and attached to the skull defect edge), and two to three cranial locks were used to fix the skull edge. 3.Results After 6-12 months of postoperative follow-up, 32 cases had good wound healing and no one had complications such as infection, subscalp fluid and rejection reaction. The review of CT and cranial X-ray showed that the fracture was well fixed, the inner and outer plates of the skull were flat, and there was no collapse or deformation of the bone flap, and the original physiological curvature and shape of the cranial cavity were restored. No osteonecrosis, osteomyelitis of bone fragments, no bone dense changes, no bone resorption were found in CT and MRI, and the cranial lock pattern was clearly visible when 3D reconstruction or line examination was performed. Discussion Depressed skull fractures account for about 30% of skullcap fractures. Cranial comminuted fractures account for approximately 2% to 3% of skullcap fractures, with the frontal bone being the most common and the parietal bone the second most common. Most of the skull depression fractures need to be treated surgically. The purpose of surgery is to thoroughly debride, remove the compression of the dura mater and brain tissue by the broken bone fragments, improve local blood circulation, repair the broken dura mater, and reduce the occurrence of epilepsy in the future. Currently, the main treatment methods are: sledging of depressed fractures. Removal of the bone flap from a depressed fracture. Excision of depressed fracture fragments. Prying and lifting of depressed fractures is only successful in some cases and can cause secondary bleeding. The removal of the fracture fragment leaves a cranial defect, and the patient often experiences dizziness, headache, nausea and other cranial defect syndromes, and also causes fear and insecurity in the patient, and requires secondary cranial repair; at the same time, there are many disadvantages of the repair material. Especially for pediatric patients, the skull is not suitable for skull repair surgery because the skull is in the developmental stage. For open comminuted skull fractures, especially open comminuted fractures, the previous treatment method is mostly Ⅰ-stage surgical debridement and Ⅱ-stage cranial repair. In contrast, open bone flap repair can shape the skull in phase I without skull defect, preserving the autologous bone and avoiding complications such as artificial skull easy to be infected, fluid accumulation, heat conduction and magnetic conduction. The rich blood supply to the scalp, strong resistance to infection and rapid healing, and the rich blood flow to the capitellum and the implanted fragmented bone can produce blood flow connection in a short time, which is the basis of one-stage cranioplasty. The dura mater is suspended and then electrocautery is performed with double-strike electrocoagulation to keep it in a tense state so that the fragmented bone can be supported at an early stage so that the skull fragment will not collapse, and the skull fragment itself can be supported by each other after repositioning according to the fracture line because the rough surface and irregular shape of the skull defect edge are preserved during wound debridement and removal. At the same time, several longitudinal and transverse fissures deep to the plate barrier are sawed on the larger fragments to increase the contact surface between the plate barrier and the subcutaneous tissue, which is conducive to the growth of new capillaries and improves the local blood circulation of the fragments. This is the key to the survival of the implanted bone fragments, formation of bone scabs and completion of bony healing. In this group of cases, the cranioplasty of the fragmented bone is done in one operation by using cranial locking combined with EC glue to fix the fragmented bone, which will not lead to cranial defects, and the fragmented bone can be viable and can heal bony and grow with the growth of the child, which is better than synthetic materials. It eliminates the pain of re-operation and reduces the economic and psychological burden of the patient; at the same time, it avoids the secondary damage to the brain tissue caused by the skull defect due to the removal of the skull fragment and has good results. The skull lock is made of titanium material, which has good histocompatibility, no rejection, and few artifacts in X-ray examination are its advantages. The bone flap can be firmly fixed with 2-3 pieces, and it is small in size and has no occupational effect. EC glue has the characteristics of high adhesive strength and short curing time, which can better solve the problem of fracture block collapse. The addition of the cranial locking and forming flap is suitable for most of the cases of depressed comminuted fractures because of its reliable fixation.