bruise
| Classification according to ICD-10 | |
|---|---|
| S00-S90 | Bruises in certain parts of the body |
| T14.0 | Superficial injury to an unspecified part of the body |
| T00.9 | Multiple superficial injuries, unspecified |
| ICD-10 online (WHO version 2019) | |
A bruise or contusion ( Latin contusio ) is the damage to organs or body parts through external violence that does not have to be accompanied by visible skin injuries . The result is edema of the tissue and blood leakage from damaged capillaries into the surrounding tissue, which can be seen as a bruise or bruise mark and is associated with pain and swelling of the affected region.
causes
Often, bruises are caused by falls, and the impact of a body part against a rigid obstacle can also cause bruises. Furthermore, there are bruises as a result of physical violence, be it in the context of abuse or physical confrontations.
diagnosis
The diagnosis of a bruise is a diagnosis of exclusion if there is a corresponding history ; Swelling, pressure and movement pain and possibly visible bruising can also be symptoms of broken bones , joint injuries or - in the abdominal area - injuries to internal organs. Therefore, a bruise can only be diagnosed using suitable methods ( X-ray examination , sonography, etc.) after such a serious injury has been ruled out. In the case of bruises to the skull, involvement of the brain ( head and brain trauma ) must be safely ruled out, i.e. in case of doubt by means of computed tomography or magnetic resonance tomography , since supposedly harmless bruise marks can be associated with intracranial bleeding , especially in patients treated with anticoagulants .
Localizations
Bruises from falls are usually found on exposed parts of the body such as the knee, hip, elbow and shoulder joints, the front edges of the shin and the skull. In these regions, bony structures are comparatively close under the skin, so that the blunt force of force is limited to a relatively small area and the lower pressure distribution leads to more significant damage than in the area of good "padding" by subcutaneous fatty tissue and muscles. Bruises outside of these zones, for example in the area of the chest or abdomen, are increasingly the consequences of blows or bumps as well as traffic accidents (“belt marks”, impact of the chest and / or stomach against the steering wheel). In certain sports, too, exposed areas of the body are often affected. For example, in competitions in the sport of Taekwondo, there are more and more bruises in the forefoot area.
Differential diagnosis
From the location, extent and shape of the bruise marks found, conclusions can be drawn about the type of trauma suffered if the course of the accident is unclear or not plausible. For example, long, straight, double-striped bump marks indicate blows with sticks or similar objects. Physical abuse can be inferred from localization on the upper and lower arms (defensive injuries), back, thighs or buttocks, which is not typical for falls. The exact documentation, especially of multiple contusions, can be of fundamental forensic importance in such cases , especially if child abuse is suspected .
treatment
Resting, cooling, applying a compression bandage, and elevation can limit the development of swelling and hematoma. An elastic bandage is useful in the further course of treatment. Ointments and gels work mainly through their cooling effect. Checks are required to observe the resorption of any hematoma. Larger, unabsorbed bruises must be surgically opened, cleared, and drained to avoid possible infection . Also in the case of the compartment syndrome after (severe) contusions, an operative procedure is indicated in appropriate cases.
Complications
- Severe bruises of the extremities, especially in the area of the calf, can lead to the compartment syndrome , which must be treated surgically immediately, as otherwise the function of the extremity is highly endangered, including amputation.
- Contusions of the abdomen ( blunt abdominal trauma ) can result in ruptures of the spleen , kidneys , liver or pancreas , which can also occur after 24–48 hours ( two-stage rupture ). Timely surgical intervention is also required in these cases.
- If the chest is bruised, breathing can be restricted by the pain when moving.
- In the medium term, contusions with involvement of the muscles can lead to the formation of soft tissue ossification (" heterotopic ossification ") with the consequence of chronic pain and / or functional losses.
- In bone contusions ( bone bruise ) there may be a bone marrow edema occur.
Web links
Individual evidence
- ↑ S. Grüne (Ed.): Anamnesis - Examination - Diagnostics . Springer-Verlag, Berlin / Heidelberg 2007, ISBN 3-540-32866-1 , p. 342 .
- ↑ Braun T .: Injuries in high-class Taekwondo tournaments - a position assessment . In: German Journal of Sports Medicine ., 1999, p 239 ff, ISSN 0344-5925 , sportmedizin.org ( MS Word ).
- ↑ B. Herrmann, S. Banaschak, R. Dettmeyer, U. Thyen: Child abuse: Medical diagnostics, intervention and legal bases . Springer-Verlag, Berlin / Heidelberg 2010, ISBN 3-642-10206-9 , p. 51 ff .
- ↑ M. Upper Ringer, T. Pohlemann: compartment syndrome . In: H.-P. Scharf, H. Rüter et al. (Ed.): Orthopedics and trauma surgery . 1st edition. Elsevier - Urban & Fischer, Munich 2009, ISBN 978-3-437-24400-1 , pp. 11-15 .
- ↑ JR Siewert, RB Brauer: Basic knowledge of surgery . 2nd Edition. Springer, Berlin / Heidelberg 2010, ISBN 3-642-12379-1 , chap. 7.17 Spleen , p. 330 ff .
- ^ Franz Müller: Heterotopic Ossifications , Chapter 18.2.3. In: Bernhard Weigel, Michael Nerlich (eds.): Praxisbuch Unfallchirurgie , Volume 2, pp. 1086-1088, Springer-Verlag, Berlin 2005, ISBN 3-540-41115-1
- ^ Bone bruise and bone marrow edema in athletes. In: Sportärztezeitung. Retrieved October 11, 2018 .
