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Bone Contusion

A bone contusion (bone bruise) is a relatively common injury to a bone that is less severe than a bone fracture, resulting in injury to the bone on a microscopic level, without a discrete or visible fracture line on xray or advanced imaging such as MRI or CT scan. Bone contusions may occur in any bone, and may happen to people of all ages and activity level.

Bone contusions are a common sports injury. Bone contusions may occur as isolated injuries, or they may occur in conjunction with injuries to ligament, tendon, cartilage, or other structures. For instance, most anterior cruciate ligament (ACL) tears include acute bone contusions to the lateral femoral condyle and lateral tibial plateau at the time of the injury. Isolated bone contusions often result from direct impact, such as colliding with another player in contact sports such as football, soccer, basketball, or rugby.

Diagnosis of a bone contusion can often be made from clinical history and exam with reasonable certainty. Based on the preferences of the patient and circumstances of the injury (professional versus recreational athlete, in-season versus off-season, etc.), an individualized approach will determine whether advanced imaging is necessary.

Types of treatment

Treatment for a bone bruise may include:

  • Resting the bone or joint, including crutches to support your weight
  • Putting an ice pack on the area several times a day to decrease swelling and pain
  • Raising the injury above the level of your heart to reduce swelling
  • Taking medicine to reduce pain and swelling, most commonly a non-steroidal anti-inflammatory (NSAID)
  • Wearing a brace or other device to limit movement, if needed; often a pad is helpful when returning to sport, as the area is more sensitive to contact until fully healed

Diet is another opportunity to accelerate healing. Similar to fractures of the bone, eating a diet rich in calcium, vitamin D, and protein can help you heal bone contusions faster. In contrast, certain factors work against an athlete and delay healing of a bone contusion, such as smoking and diabetes.

Most bone bruises slowly heal over 4-8 weeks, although this can vary considerably based on the age and health of the athlete, as well as the size and location of the bone contusion. In general, a larger bone bruise may take longer to heal.

Possible complications of a bone bruise

Most bone bruises heal without any problems. Rarely bone bruises are severe and very large, and a portion of the bone may die due to permanently compromised blood supply. This is referred to as avascular necrosis or osteonecrosis of the bone. Although rare, this comprises an important reason to seek evaluation by an orthopedic surgeon and follow-up until the injury is resolved, with return to sport only when deemed safe by the medical team including the physician, therapist, and trainer.

Frequently Asked Questions

  • Do I need an MRI to diagnose a bone contusion?
    • Many bone contusions, particularly direct contact injuries, can be diagnosed with a combination of normal x-rays and direct tenderness on the bone, as determined by physical exam. This more ‘clinical’ diagnosis is certainly more cost-effective. Nonetheless, for the highest degree of sensitivity and specificity, MRI is the gold standard test, and often is used not only to confirm the clinical diagnosis of bone contusion, but also to assess for other possible concomitant injuries such as ligament, meniscus, or cartilage injury.
  • What is the difference between a bone contusion and a bone bruise?
    • These terms are synonymous. As with the terms ‘fracture’ and ‘broken bone,’ the former term is the more official medical term, and latter is the more commonplace or lay term.
  • What is the difference between a bone contusion and a bone marrow lesion?
    • These terms cause confusion and disagreement even among orthopedic surgeons. In Dr. Rice’s practice, bone contusion generally connotates a more acute or sudden traumatic injury, such as knocking knees with an opposing player in soccer. A bone marrow lesion looks similar on an MRI, but has a connotation of a more chronic lesion, often caused by long-term excessive stress to the bone, as in the medial femoral condyle or medial tibial plateau coinciding with a medial meniscus tear and medial cartilage loss (osteoarthritis). In that example, the bone marrow lesion is yet another indicator of a knee compartment that is failing under excessive stress.
  • What can I do to make a bone contusion heal faster?
    • In short, not much. Mother nature must take its course. The most common mistake by patients is to stubbornly persist in sport or activity that causes pain and prohibits healing, thereby greatly extending the healing time. Remember the basics of RICE: rest, ice, compression, elevation. This mostly addresses the symptoms, and may not significantly affect healing. In Dr. Rice’s practice, calcium and Vitamin D intake are encouraged, naturally when possible and if needed via supplementation. This is intuitive and anecdotally helpful, but high quality research does not exist to support this treatment. On the other hand, Dr. Rice perceives the potential morbidity or harm to approach zero in most patients, and it may provide additional nutrients to support bone healing on a microscopic level. Additionally, Dr. Rice has noted especially in the Cincinnati area, many patients have low Vitamin D levels or even Vitamin D deficiency, which may have been a predisposing risk factor in developing a bone contusion in the first place. While very select cases of bone marrow lesions may benefit from subchondroplasty, Dr. Rice does not recommend surgery for acute traumatic bone contusions. This question in particular highlights the value of a personalized assessment with Dr. Rice.
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