What is the treatment for a hematoma on the left hip after a fall?

Treatment of Hematoma Left Hip After a Fall

The treatment for a hematoma on the left hip after a fall should focus on conservative management with rest, ice, compression, and elevation (RICE), along with appropriate pain control using regular paracetamol, while monitoring for complications such as infection or neurovascular compromise.

Initial Assessment and Management

Immediate Care

• Apply ice to the affected area for 15-20 minutes every 2-3 hours for the first 24-48 hours to reduce swelling and pain
• Rest the affected hip to prevent further injury
• Consider compression bandaging if appropriate to limit swelling
• Elevate the affected area when possible

Pain Management

• Regular paracetamol administration should be the first-line analgesic 1
• Non-steroidal anti-inflammatory drugs (NSAIDs) should be used with extreme caution, particularly in elderly patients or those with renal dysfunction, as they can increase bleeding risk 1, 2
• Opioids should be used cautiously, especially in patients with renal dysfunction, with reduced dosing and frequency 1
• Avoid codeine as it is constipating, emetic, and associated with cognitive dysfunction in elderly patients 1

Special Considerations

Anticoagulation Management

• If the patient is on anticoagulants (e.g., warfarin, aspirin, clopidogrel), assess the risk-benefit ratio of continuing therapy 1
• For patients on warfarin with significant hematoma, consider checking INR and adjusting therapy if necessary 1
• Aspirin may be withheld during recovery unless indicated for unstable angina or recent/frequent transient ischemic attacks 1
• Clopidogrel generally should not be stopped, especially in patients with drug-eluting coronary stents 1

Monitoring for Complications

Watch for signs of:

• Expanding hematoma (increasing pain, swelling)
• Infection (increasing warmth, redness, fever)
• Neurovascular compromise (numbness, tingling, weakness, pallor)
• Femoral nerve compression (weakness in hip flexion or knee extension, sensory changes in anterior thigh) 3

Advanced Assessment When Indicated

Imaging Considerations

• Ultrasound can be useful for detecting and monitoring subperiosteal hematomas of the iliac bone 4
• CT or MRI may be indicated if:
  • Pain is severe and disproportionate to visible injury
  • Neurological symptoms develop
  • Hematoma appears to be expanding
  • Underlying fracture is suspected 4, 5

When to Consider Intervention

Surgical drainage may be indicated when:

• Severe pain persists despite conservative management
• Neurological deficits are present (e.g., femoral nerve palsy)
• Hematoma is large and expanding 3
• Joint tamponade is suspected (severe pain with restricted motion) 5

Aspiration considerations:

• May provide immediate relief in cases of joint tamponade 5
• Should be performed under sterile conditions
• Consider if pain is severe and restricting mobility

Follow-up Care

Rehabilitation

• Once acute pain subsides, gentle mobilization should be encouraged
• Physical therapy may be beneficial to restore normal gait and function
• Secondary prevention of falls should be considered, especially in elderly patients 1

Nutritional Support

• Ensure adequate nutrition to support healing, particularly in elderly patients who may be malnourished 1

Pitfalls and Caveats

• Do not miss underlying fractures that may present with similar symptoms to isolated hematoma 5
• Be vigilant for iliopsoas hematoma in patients with acute hip and back pain after a fall, especially if on anticoagulants 6
• Spontaneous hematomas can occur in patients on NSAIDs, even without trauma history 2
• Elderly patients are particularly susceptible to pressure damage; ensure proper positioning during rest periods 1

By following this approach, most hip hematomas will resolve with conservative management, while ensuring that more serious complications are identified and addressed promptly.