Management of Left Hip Hematoma
The treatment of a left hip hematoma requires immediate assessment of severity followed by appropriate intervention, ranging from conservative management to surgical evacuation depending on the clinical presentation.
Initial Assessment
- Evaluate the extent and severity of the hematoma using established clinical grading systems 1
- Look for obvious blood loss, injury patterns, and assess vital signs (skin color, heart rate, blood pressure, capillary refill, consciousness) 1
- Determine if the patient is hemodynamically stable - if conscious with palpable peripheral pulse, blood pressure is likely adequate 1
- Obtain baseline laboratory tests including complete blood count, coagulation profile (PT, aPTT, fibrinogen), and cross-match 1
Conservative Management (For Small to Moderate Hematomas)
- Rest, ice, compression, and elevation (RICE) of the affected hip 2
- Adequate pain management with regular analgesics 3
- Monitor for signs of hematoma expansion with serial physical examinations 4
- Consider imaging (ultrasound, MRI) to assess size and location of the hematoma 4
Indications for Surgical Intervention
- Large or expanding hematoma causing significant pain or functional limitation 2, 5
- Signs of compartment syndrome or neurovascular compromise 2
- Skin necrosis or impending necrosis due to pressure from the hematoma 2
- Failure of conservative management with persistent symptoms 5
Surgical Management Options
- Surgical evacuation of the hematoma under appropriate anesthesia 2
- For large hematomas, consider vacuum-assisted closure following evacuation 5
- In cases with significant tissue damage, fascioplasty or skin flap repair may be necessary 5
Special Considerations
Anticoagulation Management
- If the patient is on anticoagulants, consider reversal agents based on the specific medication 1
- For vitamin K antagonists (warfarin), four-factor prothrombin complex concentrate is recommended when INR ≥2.0, followed by intravenous vitamin K 1
- For direct oral anticoagulants, specific antidotes should be administered if available 1
- For heparin (unfractionated or low-molecular-weight), protamine sulfate can be used for reversal 1
Blood Component Therapy
- For significant blood loss, provide warmed blood and blood components 1
- Consider early infusion of fresh frozen plasma to prevent dilutional coagulopathy 1
- Cell salvage should be considered for procedures involving significant blood loss 1
Post-Treatment Care
- Admit to appropriate level of care for monitoring of vital signs, coagulation parameters, and hemoglobin 1
- Assess wound drains (if placed) to identify ongoing or recurrent bleeding 1
- Initiate standard venous thromboprophylaxis as soon as bleeding is controlled 1
- Begin early mobilization to improve outcomes 3
Complications to Monitor
- Recurrent bleeding or hematoma expansion 6
- Infection of the hematoma 6
- Neurovascular compromise 7
- Long-term complications such as fibrosis or calcification of the hematoma 6
Hip hematomas can significantly impact morbidity and mortality if not properly managed, particularly in patients with underlying coagulopathies or those on anticoagulant therapy 6.