What is the treatment for a bone contusion?

Treatment of Bone Contusions

The primary treatment for bone contusions consists of cold therapy application for 15-20 minutes several times daily during the first 48-72 hours, along with rest, pain management with NSAIDs, and gradual return to weight-bearing activities based on symptom resolution. 1

Understanding Bone Contusions

Bone contusions are traumatic injuries to the bone that don't appear on standard radiographs but can be visualized on MRI as areas of edema within the bone. They typically occur from direct trauma or axial overloading of the bone.

First-Line Treatment Approach

Immediate Management (First 48-72 hours)

• Cold therapy: Apply ice packs for 15-20 minutes several times daily

  • Use a plastic bag or damp cloth filled with ice and water mixture (more effective than ice alone) 2
  • Place a barrier like a thin towel between the cold container and skin
  • Limit application to 20 minutes (or 10 minutes if uncomfortable) to prevent cold injury

• Rest: Avoid weight-bearing or minimize stress on the affected area

  • For lower extremity bone contusions, avoid bearing weight until advised by a medical professional 2

• Pain management:

  • NSAIDs for pain control
  • Topical NSAIDs (diclofenac gel/patch) for localized pain with minimal systemic effects
  • Acetaminophen as an alternative for those who cannot tolerate NSAIDs 1

Subsequent Management

1. Gradual mobilization:

   • Begin gentle range-of-motion exercises as pain allows
   • Progress to strengthening exercises as symptoms improve
   • Gradually return to normal activities based on symptom resolution 1

2. Follow-up imaging:

   • MRI is the gold standard for diagnosing and monitoring bone contusions 2
   • Consider follow-up MRI if symptoms persist beyond expected healing time

Special Considerations

Bone Contusions Associated with Ligament Injuries

Bone contusions frequently accompany ligament injuries, particularly ACL tears. Studies show that:

• 84% of ACL ruptures have associated bone contusions 3
• The presence of bone contusions in partial ACL tears may indicate a high-grade injury with 80% progressing to complete rupture within 6 months 4

Monitoring for Complications

• Monitor for signs of fracture development or progression
• Be aware that bone contusions may be predictive of the development of focal osteoarthritis 1 year after trauma 2

Rehabilitation Timeline

1. Acute phase (0-72 hours): RICE protocol (Rest, Ice, Compression, Elevation)
2. Sub-acute phase (3-14 days): Gradual increase in range of motion and light weight-bearing
3. Recovery phase (2-8 weeks): Progressive strengthening and return to activities
4. Return to full activity: Based on complete resolution of symptoms and functional recovery

Treatment Pitfalls to Avoid

• Returning to activities too soon before adequate healing
• Inadequate pain management leading to compensatory movement patterns
• Failing to recognize associated injuries (like meniscal tears or ligament damage)
• Not providing complete RICE treatment (studies show this is rarely fully applied in emergency settings) 5

The treatment approach should be adjusted based on the location and severity of the bone contusion, with special attention to associated injuries that may require additional management.