Positive “Water Test”—An External Indicator of Base of Skull Hinge-Ring Fracture

Abstract: Despite having significant internal injuries, victims of motor vehicle accidents may have surprisingly few external manifestations of trauma. The water test describes a technique whereby water placed in an upwardly facing ear results in drainage from the nose and opposite ear, thus demonstrating transcranial passage of water. This sign can be demonstrated in cases of blunt cranial trauma where there is a “hinge” fracture involving the petrous temporal bones bilaterally associated with a ring fracture extending around the foramen magnum posteriorly. Such a fracture results in separation of the posterior and middle cranial fossae providing a track for water to traverse. The water test provides a quick and noninvasive method for demonstrating the presence of a particular type of skull fracture.