A fracture is when a break or crack occurs in the structure of the bone, affecting the outer cortex. If a traumatic injury damages the inner layer of the bone without showing a visible fracture on X-rays, it is referred to as a bone bruise. It affects the trabeculae (the small, spongy structures inside bones that provide support and help maintain the bone’s strength).
“Here the force transmitted through the body during an impact or fall is not high enough to cause a bone fracture. But it causes trabecular damage and results in bone bruises,” says Dr Anindansu Basu, consultant orthopaedics, Fortis Hospital, Anandpur, Kolkata. “The risk of trabecular rupture becomes higher if your bone is weak.”
While fractures, depending on their severity and type, may require treatments including surgery, bone bruises usually heal without surgical intervention.
How to identify a bone bruise?
Pain that is accompanied by redness and swelling in the affected area is the primary indicator of a bone bruise. It eventually turns into a restriction on movement in the injured area.
“Think if you had a bone bruise in your knee, which would cause excruciating pain whenever you tried to load the knee joint,” says Dr Basu.
Since a fracture or crack in the bones can also cause all these symptoms, doctors may recommend an MRI to detect the bruise and determine the degree, precise area, and size of the injury.
When X-rays are commonly used to identify fractures, they are ineffective in identifying bone bruises. “A bone bruise cannot be seen on an X-ray. Because standard X-rays cannot show trabeculae,” explains Dr Basu.
Who is prone to a bone bruise?
According to experts, most cases of bone bruises occur in athletes, and they are usually associated with trauma.
“It is a relatively common injury in contact games like basketball, football, rugby, hockey, etc.,” says MA Joseph, consultant sports physiotherapist, Regional Sports Center, Kochi, and chief physiotherapist at Medical Trust Hospital, Kochi.
“A bone bruise can result from direct impacts during tackles or falls in football. In hockey, it can occur from another person’s hockey stick hitting your lower leg by accident,” adds Joseph.
Bone bruises are also common in the population of those who have osteoporotic bones. The reduced structural integrity of osteoporotic bones increases the risk of bone bruising, says Dr Basu.
Preventive measures for athletes
Joseph advises athletes to wear the appropriate safety gear to reduce their chance of getting a bone bruise during a game.
“Wearing protective gear like shin guards and shoulder pads while playing hockey, shoulder pads, knee and thigh pads while playing football, etc., will help to avoid injuries like bone bruises,” says Joseph. “Choosing a hazard-free ground or field for playing is another important aspect in ensuring safety.”
Treating a bone bruise
The first step in managing a bone bruise is RICE (Rest, Ice, Compression, and Elevation). Rest can be made more effective by protecting the injured area by offloading it.
“Wearing a kneecap or brace to restrict the movements is ideal [in case it is a knee bone bruise],” says Dr Basu.
Depending on the natural healing capacity of the bone, if your bone is in good condition, the healing time of a bone bruise is usually two to three weeks.
“If you are dealing with osteoporotic bones where the trabecular or bone matrix is already weakened, it tends to take more time for recovery. It will take around 6 to 8 weeks, or 10-12 weeks at the most. If not, there’s a problem that must be further investigated,” says Dr Basu.
Takeaways
- When a break or crack in a bone’s structure affects the bone’s outer cortex, it results in a fracture. On the other hand, a bone bruise affects the trabeculae and damages the inner layer of the bone.
- The primary sign of a bone bruise is pain that is accompanied by redness and swelling in the area that is bruised.
- Most bone bruise incidents happen to athletes and are associated with trauma, which can be prevented by wearing protective gear.
- RICE (rest, ice, compression, and elevation) is the first step in treating a bone bruise, followed by offloading the affected area.
