Bone bruise
Original Editors - Laurien Henau as part of the Vrije Universiteit Brussel's Evidence-based Practice project.
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What is a bone bruise?
A bone bruise is a type of bone injury.
- Other examples of bone injuries include stress fractures, osteochondral fractures and a variety of different patterns of bone fractures.[1]
- A bone bruise is characterised by three different kinds of bone injuries including: sub-periosteal hematoma, inter-osseous bruising and a sub-chondral lesion, or a combination of these. [2]
Clinically Relevant Physiology
Bone tissue is a specialised form of connective tissue that is made up of an organic matrix (collagen and glycosaminoglycans) and inorganic minerals (calcium and phosphate). [3] An adult human skeleton contains 80% cortical bone and 20% trabecular bone. Both types of bone are composed of osteons. Cortical bone is the solid type of bone and trabecular bone resembles honeycomb which is comprised of a network of trabecular plates and rods.
Epidemiology
The most common cause of bone bruise is trauma however the condition can also be associated with normal stress loading and haemophilia A and B.[4]
The most commonly affected area is the lower limb. [5]
Patients with a bone bruise tend to have protracted clinical recovery, with more effusion and a slower return of motion. [1]
In patients with ACL rupture there is an 80% probability of concurrent associated bone bruising at the femoral condyle or tibial plateau.[1][3] According to Boks et al. 2007, the presence of bone bruising in these zones is the most important secondary sign in the diagnosis of ACL injury.
MRI with white arrow indicating presence of bone bruising in the (a) post-lateral talus area and (b) the caudal tibia epiphysis.
Clinical Presentation
| Bone Injury Type | Characteristics | Typical Injury Mechanism |
|---|---|---|
| Sub-periosteal hematoma | A concentrated collection of blood underneath the periosteal of the bone. | Direct high-force trauma to the bone |
| Inter-osseous bruising | Damage of the bone marrow. The blood supply within the bone is damaged, and this causes internal bleeding. | Repetitive compressive force on the bone (extreme pressure on regular base). |
| Sub-chondral lesion | Lesion occurs beneath the cartilage layer of a joint. | Extreme compressive force or rotational mechanism such as testing (shearing force) that literally crushes the cells
Force causes separation of the cartilage (or ligament) and the underlying bone, plus bleeding when the energy of the impact extends into the bone. |
For the all bone injuries, incidence rates tend to be higher amongst professional athletes and those that run and jump frequently on hard surfaces, for example football and basketball players. [1][2]
Diagnostic Procedures
Although an x-ray should identify whether or not there is a bone fracture, a bone bruise is not able to be diagnosed using x-ray imaging. The current "gold standard" diagnostic imaging method for bone bruises is the MRI, in particular T2-weighted fat-suppressed images or T1-weighted imaging.[3]
Physical Therapy Management
Typically, bone bruises are addressed by the reducing activities which elevate the joint symptoms.[7]. Physiotherapy need to include as a part of conservative management and its evident that this will help significantly to regain the normal pain free ROM but aggressive mobilisation should be avoided to prevent further complication.[8] The time for the resolution of a bone bruise is variable. Literature suggests that the healing time to completely resolve this injury can take anywhere between three weeks to up to two years after the trauma.[1][2]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Mandalia V, Fogg AJB, Chari R, Murray J, Beale A, Henson JHL. Bone bruising of the knee. Clinical Radiology. 2005 Jun;60(6):627–36.
- ↑ 2.0 2.1 2.2 2.3 Mandalia V, Henson JHL. Traumatic bone bruising—A review article. European Journal of Radiology. 2008 Jul;67(1):54–61.
- ↑ 3.0 3.1 3.2 L.C. Jungueira and J. Carneiro, “Functional Histology” 2010; 167
- ↑ van CREVELD, KINGMA MJ. Subperiosteal hemorrhage in hemophilia A and B. Nederlands tijdschrift voor geneeskunde [Internet]. 1961 Mar;105:1095–8.
- ↑ C. Rangger, Kathrein A, Freund MC, Klestil T, Alfons Kreczy. Bone bruise of the knee Histology and cryosections in 5 cases. Acta Orthopaedica Scandinavica. 1998 Jan 1;69(3):291–4.
- ↑ Boks SS, Vroegindeweij D, Koes BW, Bernsen RMD, Hunink MGM, Bierma-Zeinstra SMA. MRI follow-up of posttraumatic bone bruises of the knee in general practice. AJR American journal of roentgenology [Internet]. 2007 Sep;189(3):556–62.
- ↑ S. Kemal Aktuğlu, Kemal Kayaokay. Natural History of Bone Bruise. Springer eBooks. 2019 Jan 1;3–10.
- ↑ FA K, E B, U H. Are bone bruises a possible cause of osteochondritis dissecans of the capitellum? a case report and review of the literature. Archives of Orthopaedic and Trauma Surgery. 2005 Sep 2;125(8):545–9.