October 10, 2015

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What are the types of hematomas? (Part 3)

Orthopedic injuries are often associated with hematoma formation. Bones are very vascular structures since the marrow is where blood cells are made. Fractures are always associated with hematomas at the fracture site. Fractures of long bones such as the thigh (femur) and upper arm (humerus) can be associated with a significant amount of bleeding, sometimes up to one unit of blood or 10% of the body's blood supply.

Pelvic bone fractures can also bleed significantly since it takes a large amount of force to break these bones and nearby veins and arteries can also be damaged. It is very difficult to compress the area to decrease the amount of bleeding. Pelvic hematomas are hidden and the amount of blood loss may be difficult to assess.

Intramuscular hematomas can be very painful due to the amount of swelling and inflammation. Some muscles are surrounded by tough bands of tissues. If enough bleeding occurs, the pressure within these compartments can increase to the point that a “compartment syndrome” can occur. In this situation, the blood supply of the muscle is compromised and the muscle and other structures such as nerves can be permanently damaged. This is most commonly seen in the lower leg and forearm. Compartment syndrome may also be seen as a complication of fractures. This is a true surgical emergency and medical care should be accessed immediately if compartment syndrome is suspected. For the health care professional, one clue to think of the diagnosis is finding a patient whose pain is out of proportion to the physical findings. Continue Reading

Reviewed on 9/17/2015