Should I be concerned about a bone bleed?
June 23, 2010 10:32 AM   Subscribe

What is a bone bleed, and how do I know if I should be concerned? (Bike injury details within!)

On Monday, I did a spectacular swan dive off my bicycle and now have lots of big purple bruises on my legs. My right knee and left inner thigh took the brunt of it, but I still have full range of motion and surprisingly little pain despite the dramatic bruising. Most of the swelling on my knee has gone down, and I'm icing regularly.

An acquaintance physiotherapist looked at my legs before my martial arts class today, and confirmed my opinion that the damage appears to be entirely superficial. However, she was a little concerned about a slightly raised patch in the center of one of the inner thigh bruises. This raised patch is about an inch long and, although it's towards the middle of the bruise, it's much less purple than the rest of the area. If I run my finger over it, I can feel that it's raised, but it's not visibly swollen, nor is it more or less tender than the rest of the bruise. She told me to watch this raised area because it might be a bone bleed that could have complications if all the matter isn't reabsorbed into my body ... and then we went ahead and did the martial arts class.

My question, then, is: what's a bone bleed, and what should I be watching out for? Yes, you are not my doctor, but I'm not planning on going to one as I don't feel that I need one. The wikipedia entry on "bone hemostasis" refers to surgery. My thighs are quite thick and muscular; I wouldn't've thought it would be possible to damage my thigh bone just by hitting the ground (or possibly part of my bike), given that there's so much padding there.

Should I be concerned, and at what point would going to a doctor be a good idea?
posted by monkeymonkey to Health & Fitness (8 answers total)
 
Best answer: Sounds like another name for hematoma or the more popular "fucking nasty bruise man, damn!".

So your fall burst some blood veins/vessels. Happens all the time. The danger is the fluid doesn't drain out when it heals. But it'd be very rare that happens or that anything would need to be done about it. I'd ignore it for two weeks and then check to make sure the swelling has gone away.
posted by anti social order at 11:25 AM on June 23, 2010


Best answer: She may be thinking of a sub-periosteal hematoma or similar injury, more commonly referred to as a "bone bruise". These can take quite a while to heal as described in the link but should eventually heal completely. As with any hematoma there is a potential for infection so be alert for signs of infection as it heals (warmth, redness, increased tenderness, drainage of pus among others).
posted by TedW at 11:49 AM on June 23, 2010


Response by poster: Very helpful information -- thank you both! Having seen the guy pictured in the wikipedia page, I feel better about my (comparatively small) bruises.
posted by monkeymonkey at 12:41 PM on June 23, 2010


My thighs are quite thick and muscular; I wouldn't've thought it would be possible to damage my thigh bone just by hitting the ground (or possibly part of my bike), given that there's so much padding there.

This observation is what makes me wish you would go to the doctor.

Seems to me you might have hit hard enough to flex your femur beyond its elastic limit and produced a damaged weak spot in the middle of the bone where this raised patch has appeared. You could even have aggravated an incipient stress fracture.

In that case, you would really want to take it easy for a while, possibly with the aid of a cast, in order to let such an injury heal back to accustomed rigidity, and you would want to make sure the overall geometry of the femur had not been altered by the accident.

A bone scan or MRI is apparently much better for picking this kind of thing up than an x-ray.
posted by jamjam at 1:22 PM on June 23, 2010


Best answer: jamjam, a bone scan or MRI is a pretty extreme way to deal with a bruised thigh. The OP pointed out that he has very little pain except for superficially over the bruise, and full range of motion. This description makes it sound unlikely that there are any hidden fractures. Pain is a hallmark of broken bones.

monkeymonkey, as a physician I think the term 'bone bleed' is incorrect and misleading (I've never heard that term before). Bones have marrow inside them that will bleed like crazy - if the bone is broken. IANYD, but as I say it doesn't sound like you have any broken bones. It is very difficult to walk on a broken femur, they are terrifically painful! I suspect that the swelling and bruising will go away given a week or two, and I suspect this is mostly contusion, maybe some hematoma. I recommend ice, Tylenol, and elevating the leg on a pillow when you're sitting to help keep swelling down. I recommend going to your doctor if: you have increasing pain, you have persistent pain after a week, you have increasing swelling/firmness of the affected area despite the recommended measures. Let me repeat that IANYD and you can always call your doctor to ask if you have any question about your symptoms and what to do.
posted by treehorn+bunny at 2:41 PM on June 23, 2010 [1 favorite]


Just to add, that if it is damage to the periosteum it can take a long time to heal - I had a lump on my shin after cracking it badly on a chair that took months to clear up because the time it takes to remodel bone is much longer than soft tissue injury. It was tender for that time, but had no effect on mobility.
posted by Coobeastie at 4:35 PM on June 23, 2010


Response by poster: Thank you all for your responses and for informing me about my bones! Please rest assured that I will go to a doctor if anything painful or unusual develops.
posted by monkeymonkey at 7:39 PM on June 23, 2010


also, think horses not zebras......

the sheer force of the blow will have sealed the smaller vessels in the impact zone, pressing blood and bursting the surrounding tissues small vessels which is prob why you have the patch of lighter colour in the middle.
It is highly unlikely you are walking around with something that has affected one of the sturdiest (if not the) bone in your body without significant pain/discomfort/ gait issues... honest.

Lots of water and a healthy diet protein wise to ensure normal healing
posted by Wilder at 3:16 AM on June 24, 2010


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