What's the confusion about the contusion?
It was December 2008 when I posted a blog entitled, Bone contusions – are they really fractures? The conversation from readers was absolutely intriguing. But the irony of the post is that in the past nine years, there doesn’t seem to be any more clarity regarding the treatment of bone contusions. So again I ask, are bone contusions really fractures?
The confusion regarding bone contusions lies in a simple treatment paradigm used in medicine. Here’s how medical consensus works;
- Define the problem and publish your findings in the literature.
- Allow the community of providers (readers of the literature) to define consensus regarding the problem.
- Consensus then leads to an optimal treatment plan for the problem.
- Optimal treatment become the community standard of care.
Ironically, this process, or paradigm has yet to develop in the medical/surgical community regarding bone contusions.
What is a bone contusion? Bone contusions (also called a bone bruise) are injuries that result in swelling, or bone edema. Bone contusions are most common following an injury such as a common sprain. Bone contusions are often found adjacent to joints but can also be found secondary to direct trauma to the bone.
I’ve been seeing a worker’s comp patient since his original injury in October of 2017. The patient was working outdoors and sprained his ankle on the edge of the road pavement. When his ankle failed to heal, an MRI found bone edema in the calcaneus (heel bone) specific to the posterior facet of the subtalar joint. Physical therapy and rest failed to decrease the pain in the subtalar joint, therefore subchondroplasty was recommended. Subchondroplasty is a percutaneous technique that is used to inject calcium phosphate, a bone substitute, into the fracture site. The patient sought a second opinion. Unfortunately, the second opinion came back as a ‘high acuity attenuation of the ankle ligament’. The second opinion was inconsistent with the MRI which clearly defined a bone contusion. This places the patient in a position of ‘bone contusion confusion’.
How can we do better in the treatment of bone contusions?
How do we raise the bar of understanding related to bone contusions? You have to think of the medical community as a very large boat that is hard to steer and even harder to turn around. In a recent surgical seminar that I attended, bone contusions and subchondroplasty were a hot topic. But in the general community, there’s far less understanding of this condition.
So again I ask - are bone contusions really fractures? They certainly are. There, it’s officially published.