A bone bruise is thought to occur when there is a microscopic fracturing of the internal bone structure. While these microfractures don’t significantly weaken the bone, they can cause bleeding and inflammation within the bone. This can lead to pain and symptoms similar to a more familiar soft-tissue bruise.
Vascular anomalies, decreased fibrinolysis (especially in pregnant women), and thromboembolism have all been proposed as possible etiologies, but a definitive cause remains elusive. Ultimately, the pain is likely caused by the aggravation of neurovascular bundles within the bone marrow due to increased intraosseous pressure caused by the increased fluids in the bone marrow interstices.
It can be caused by injury, arthritis, osteoporosis, tumors, or infections. It is frequently misdiagnosed as its clinical presentation is highly variable and nonspecific. As such, it may be referred to by many terms, including “transient osteoporosis,” “regional migratory osteoporosis,” and “algodystrophy.”
The diagnosis is based on the MRI, with high bone marrow signal T2, fluid sensitive, fat depressed.
The three O’s are the goal of the treatment: promote healing: osteoconduction–osteoinduction–osteogenesis.
Non-weight bearing (activity modification), anti-osteoporotic drugs, vitamins (bisphosphonates and vitamin D supplementation), special physiotherapy machines, and hyperbaric oxygen treatments constitute the conservative treatment.
In cases of persistent bone bruise, osteoarthritis, and early stages of avascular necrosis, we are doing a core decompression of the lesion and direct application of PRP and bone marrow concentrate stem cells according to the Intraosseous Bioplasty IOBP/Biofiller technique of Arthrex. We also use microfragmented-fat delivered intraosseous and intraarticular under arthroscopic and fluoroscopic control.