Data are given of a consecutive series of 225 cases with depressed skull fracture, admitted within 48 hours after the accident. The series is considered to represent the full range of this type of injury in a densely populated area in the Netherlands. The predominance of young male patients with a compound fracture is stressed. The data are compared with other series. The results of long-term follow-up are presented and particular attention is paid to the rate of early and late epilepsy and persisting neurological deficit. The significance of complications like intracranial haematoma and venous sinus involvement is confirmed. Treatment is discussed. In 66% of cases, most of which were compound, some even severely contaminated, the indriven bone fragments were completely or partially replaced with excellent cosmetic result and low infection rate.