In the search for knowledge, the family medic will find many articles on trauma leading to bone fractures. All problematic bone injuries do not involve breaks, however: They may cause the formation, instead, of a “bone contusion,” better known as a bone bruise.
WHAT HAPPENS IN A BONE BRUISE?
Bones are living tissue capable of suffering internal injury without obvious external signs. In bone bruises, the hard outer layer of the bone remains intact. It’s the spongy inner bone material (called “trabecular bone”) that is damaged, sometimes with the accumulation of inflammatory fluid or blood deep in the bone marrow. The superficial cover of the outer bone known as the “periosteum” may also be affected. The periosteum is a thin membrane of connective tissue that acts like a protective sheath. It provides support for bone growth and repair. (That’s all the anatomy for today).
Bone bruises ordinarily wouldn’t show up in an impressive way on x-ray like a fracture does. They are, admittedly, a step below an actual “broken bone.” That doesn’t mean they aren’t a big deal. The family medic in survival settings is likely to encounter them and must know how to handle it.
CAUSES OF BONE CONTUSIONS
Most, but not all, bone bruises affect the lower extremities (hip, knee, thigh bone, shin, ankle, etc.) but occasionally are seen in the spine or upper extremities. Common causes are collisions, falls, “twisting” injuries, repetitive stress on an area, or even collateral damage from ligament or cartilage trauma in, say, the knee. In fact, close to 80 percent of knee ligament damage involves bone bruising.
SYMPTOMS OF BONE CONTUSIONS
Bone bruises often act like a really bad soft-tissue bruise, but pain is deeper and more persistent than you would expect from a regular bruise injury. The pain is worse when bearing weight on the injured limb. You’ll also see:
- Stiffness
- Loss of range of motion
- Discoloration like a standard bruise (nor always, however)
- Swelling
Dull aches from a bone contusion last longer than a typical soft tissue bruise, sometimes taking weeks before discomfort and skin changes fade away. Some patients complain of pain well after visible signs disappear.
DIAGNOSIS OF BONE CONTUSIONS
contusion vs fracture
In normal times, MRI or CT scans can identify a bone contusion better than an x-ray, but you won’t have any of these options off the grid. Bone bruises can hurt as much as minor fractures but generally allow better stability, especially near joints. Some severe contusions border on what are sometimes called microfractures, especially in the trabecular bone described above.
One way to identify a bone contusion versus a fracture is with two basic tools: a tuning fork and stethoscope. Strike the tuning fork (128 hertz will do) on a surface and then place on the bone below the level of the fracture (away from the torso). Then, place a stethoscope above the level of the fracture (closer to the torso). In a fracture, sound will be decreased compared to a contusion on intact bone. Compare with the opposite, uninjured side.
TREATMENT AND MANAGEMENT OF BONE CONTUSIONS
Treatment is primarily conservative and focuses on protecting against further injury. For this, the classic RICES protocol is employed:
- Rest: Avoid weight-bearing if at all possible.
- Ice: Apply cold packs to the injured area for 20 minutes every 2 hours for the first 48 hours.
- Compression: Apply elastic wraps (not too tight) to decrease local swelling. Make sure that skin color in lower areas is not compromised.
- Elevation: Elevate the injured limb 12 inches above the level of the heart.
- Stabilization: Immobilize to prevent further damage.
Other options include the use of over-the-counter meds like ibuprofen, physical therapy to improve stiffness, and, of course, rest. Food rich in calcium, protein, and vitamin D may help support the healing process. Surgical intervention is rarely necessary, good news for the survival medic.
HOW LONG BEFORE A BONE BRUISE HEALS?
Recovery time from a bone bruise varies, dependent on location and other factors, but typically is one to three months, but severe cases can take up to six months to fully heal. While often self-limited in nature, they require patience; rushing recovery can lead to worse outcomes.
PREVENTION OF BONE CONTUSIONS
An ounce of prevention is worth a pound of cure, Proper protective gear while exerting activities of daily survival is key. Strength training and balance work to reduce fall/injury risk. Avoid rapid progression in exercises like weight training.
Even if minor, bone bruises are part and parcel of the risks of trauma in survival settings. Know what to do and you’ll keep it together, even if everything else falls apart.
Joe Alton MD
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