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Forum Name: Bone trauma and fractures

Question: Shin Trauma Not Healing after 6 months


 divalarsen - Mon Jun 07, 2010 9:34 am

I fell down stairs in January and was bruised extensively. All bruises healed normally exept one. The bruise has lost the purple/blue/green look but has a clear perpendicular line with darkened bruising exending out from the line. It is tender when massaging the area. It's hard to understand what the situation is or why this would continue so long. Should I pursue xrays or is there a way to look at the deep muscle that could be damaged? If so, what kind of specialist would I need to pursue?
 Dr.M.Aroon kamath - Sun Jun 13, 2010 2:20 am

User avatar Hi,
A bruise is caused by the seepage of blood out of the blood vessels(venules or capillaries) into the extracellular space in the vicinity.
Once formed, the bruises undergo a series of color changes from reddish(fresh),to blue or dark purple,then yellow or green & finally disappear(generally in about 2 weeks).

The spectrum of colors of bruises are due to changes in the blood as it's broken down and re-absorbed by the body.
There are two major breakdown products of the hemoglobin.
- a green pigment (biliverdin) and
- a yellow-brown pigment (bilirubin).

In your case, these colour change sequence would be expected to have been completed within 2-3 weeks.As it is not the case, certain other possibilities need be entertained.
- a sub-periosteal hematoma. Shin is very vulnerable to this as in this location, the tibia is sub-cuteneous.
- associated injury to underlying muscles/fascia.

Traumatic sub-periosteal hematomas generally are painful & tender to begin with and may get calcified with chronicity.

It may be a good idea for you to consult an orthopedic surgeon as investigations such as plain X-rays, ultrasonography or CT scanning may be required to arrive at a diagnosis.
Good luck!

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