What treatment is recommended for a persistent bruise and possible internal injury on my right flank after a traumatic fall?

Management of Traumatic Flank Bruise with Persistent Swelling and Induration

For a traumatic flank bruise with persistent swelling and induration one week after injury, conservative management with rest, ice, compression, and elevation (RICE) is recommended as the primary treatment approach. 1

Assessment of the Injury

When evaluating a patient with a traumatic flank injury showing bruising and a hard spot (induration) one week after the incident, consider:

• Location: Right flank, 2 inches above waistline
• Timeline: 1 week post-injury
• Current symptoms: Bruising in healing stages, puffiness, palpable hard spot
• Mechanism: Slip and fall onto pool slide

Key Physical Examination Findings to Document:

• Extent and color of bruising (indicates healing stage)
• Size and consistency of the indurated area
• Tenderness on palpation
• Any signs of infection (increased warmth, redness, purulent drainage)
• Vital signs to rule out systemic involvement

Treatment Recommendations

Immediate Management

1. Wound Care

   • Clean the area gently with warm potable water if there are any abrasions 1
   • Cover with a clean, non-adherent dressing if skin is broken

2. RICE Protocol

   • Rest: Limit activities that cause pain in the affected area
   • Ice: Apply cold packs for 15-20 minutes every 2-3 hours to reduce swelling
   • Compression: Use gentle compression with an elastic bandage if tolerated
   • Elevation: When possible, position the body to reduce dependent edema

Pharmacological Management

• Over-the-counter analgesics for pain control:
  • Acetaminophen or NSAIDs as needed for pain and inflammation
  • Avoid NSAIDs if there's any concern for internal bleeding

Monitoring

• Monitor for signs of potential complications:
  • Increasing pain
  • Expanding bruise
  • Fever
  • Abdominal pain or distension
  • Dizziness or lightheadedness (suggesting blood loss)

When to Seek Further Medical Attention

The patient should return for further evaluation if any of the following occur:

• Increasing pain or swelling
• Expansion of the bruised area
• Development of fever
• Signs of infection
• Dizziness, weakness, or other systemic symptoms

Imaging Considerations

For this patient with a stable presentation one week after injury, routine imaging is not initially required. However, imaging should be considered if:

• Pain is severe or worsening
• The hard area is expanding
• There are signs of infection or systemic illness

If imaging is needed:

• Ultrasound can be useful for detecting fluid collections 1
• CT scan with IV contrast would be appropriate if there's concern for underlying organ injury 1

Special Considerations

Possible Internal Injury

While most superficial contusions resolve with conservative management, the presence of a persistent "hard spot" warrants careful monitoring. This could represent:

• Normal healing with fibrosis
• Hematoma in resolution phase
• Rarely, an underlying injury to deeper structures

Expected Recovery Timeline

• Bruising typically resolves within 2-3 weeks
• Induration may take longer to resolve completely, up to 4-6 weeks
• Persistent or worsening symptoms beyond 2 weeks should prompt re-evaluation

Follow-up Recommendations

• Follow up in 1-2 weeks if symptoms persist or worsen
• Earlier follow-up if any warning signs develop

The majority of uncomplicated contusions will resolve with conservative management. The presence of stable vital signs, improving symptoms, and absence of systemic symptoms are reassuring signs that the injury is healing appropriately.