What is a bone contusion?

A bone contusion, also known as a bone hematoma, is a traumatic injury traumática que ocorre quando um osso sofre um impacto forte, mas não a ponto de ser uma fratura. Em vez disso, pequenos vasos sanguíneos se rompem, o que gera um sangramento dentro do osso ou em sua superfície com acúmulo de sangue e/ou líquido proveniente dos vasos e células afetados.

Symptoms

The symptoms of a bone contusion may vary depending on the severity of the injury and the location of the affected bone:

pain: this is the main symptom of a bone contusion. It can range from mild to severe, depending on the severity of the injury. The pain is usually localized in the affected area and may worsen with movement
swelling: may occur in the affected area due to bleeding inside the bone or in the surrounding soft tissues. The swelling may be visible and palpable
bruising: there may be a purple or red mark on the skin over the contusion site, which will change color over the days. It may also appear in areas below the trauma site due to the effect of gravity
tenderness to touch: the affected area may be sensitive to touch and painful when pressed. Tenderness is common in bone contusions
limited range of motion: depending on the location and severity of the contusion, there may be a temporary limitation of movement in the affected area. Movements involving the affected bone may be painful or difficult to perform

Causes

A bone contusion is caused by direct trauma to the site, which may result from:

vehicle accidents: collisions involving cars, motorcycles, bicycles, or other vehicles can result in bone contusions due to the rapid and intense impact
falls: falling from a significant height or tripping and falling onto a hard surface can cause bone contusions, especially in areas such as the wrists, hips, and elbows
sports injuries: especially in contact sports such as football, rugby, hockey, and martial arts. In these, the risk of bone contusions is higher due to collisions with other players, falls, or impacts against hard surfaces

Diagnosis

The diagnosis of a bone contusion is usually made by an orthopedic doctor, based on the following factors:

medical history: questions about the patient’s medical history, including a description of the accident that caused the injury, symptoms, pain intensity, any treatment already performed, and history of previous injuries
physical examination: the affected area will be examined for signs of swelling, bruising (purple areas), tenderness to touch, and bone deformities. They may also assess the range of motion of the affected area—that is, how much the patient can move the site—and check the stability of the bone and nearby joints
imaging tests: in some cases, imaging tests may be requested to rule out fractures and confirm the diagnosis of a bone contusion, assessing the extent of the injury. The most commonly used routine test is a simple X-ray, which helps primarily to rule out the presence of fractures or dislocations. A computed tomography (CT) scan may be requested if fractures are suspected; if the main suspicion is a bone contusion, it is less commonly used. Magnetic resonance imaging (MRI) is the best test to show bone contusions and injuries in nearby soft tissues. It is generally not necessary in emergency care but may be performed later to complement the diagnosis