Hematomas After a Car Accident: Recovery and Treatment Tips

Hematoma after a car accident?

I had a car accident on September 24th, where my right foot was pinched between my motorcycle and a car door, resulting in two stitches and some bruising.
The ankle area was not sprained, but it did swell up.
I had an X-ray, and there were no issues with the bones.

Two days before the stitches were removed, I had some images taken.
Today, I went back to the hospital to have the stitches removed, but the area where my foot was pinched has not reduced in swelling.
The doctor said it is a hematoma, and the blood clot will resolve on its own.
He advised against applying heat or massaging the area.
Since it is a blood clot, it cannot be aspirated with a needle, so there is no risk of infection.
If there is inflammation, I do not need to return unless surgery is required to remove it.
I have images from today after the stitches were removed.
I would like to ask the following questions:
1.
Why did the doctor advise against applying heat? When I asked, he only said not to massage it.
I had continued follow-up visits, and another doctor said I could start applying heat (before the stitches were removed), while another said it was up to me.
So, can I apply heat or not?
2.
What methods can I use to speed up the reduction of swelling? Can I use Arnica? I read online that it helps with bruising.
3.
If the swelling persists, will it lead to muscle fibrosis, calcification, or myositis ossificans?
4.
If the swelling does not subside, how long should I observe it before returning for a follow-up?
5.
It has been almost two weeks since the 24th; do I still need to keep the injured area elevated?
6.
Am I recovering slowly? It has been two weeks, and the blood clot has not dissipated?

Bran, 20~29 year old female. Ask Date: 2015/10/07

Dr. Ke Fangxu reply Surgery

1.
The principle for treating trauma is to apply ice within the first 48 hours to reduce swelling in the injured tissue.
After 48 hours, heat therapy should be used to promote blood circulation, so you should be applying heat now.

2.
Hirudoid can be used, but it is only effective for superficial bruising; it has limited efficacy if a hematoma has already formed.

3.
It will not persist indefinitely; however, the absorption of the blood clot may be slow, and once fully absorbed, it may leave behind fibrotic or calcified remnants.

4.
You can return for a follow-up after two weeks, or you may try applying Hirudoid for a week first.

5.
Elevating the injured area is also something that should have been done in the initial stages of injury; doing it now may not be very helpful.

6.
If a hematoma from a bruise is large and absorbs slowly, it is common to perform an incision to remove the clot early on, or to wait until the second or third week for the clot to liquefy before aspirating it with a syringe.
If this is not done, it is not unusual for the clot to take 1-2 months to completely disappear.
If you do not wish to undergo surgical treatment, there are no other methods to quickly eliminate the clot.

Reply Date: 2015/10/07

More Info

After a car accident, the presence of hematomas and bruising can be concerning, especially when recovery seems slow. In your case, it appears that you have sustained a hematoma in your right leg, which has not yet resolved after two weeks. Let's address your questions and provide some insights into recovery and treatment.

1. Why did the doctor advise against heat application?
Heat can increase blood flow to an area, which may exacerbate swelling and inflammation, particularly in the acute phase of an injury. In the case of a hematoma, applying heat could potentially lead to increased bleeding within the hematoma, making it larger and prolonging recovery. Cold therapy, on the other hand, is typically recommended in the initial stages to reduce swelling and numb pain. It's important to follow your doctor's advice, especially if they have assessed your specific situation.

2. Methods to expedite swelling reduction:
While your doctor has advised against heat, there are other methods to help reduce swelling. Resting the affected area, elevating your leg above heart level, and applying ice intermittently can be beneficial. Compression wraps may also help manage swelling, but they should not be too tight to avoid restricting blood flow. As for using topical treatments like arnica (often referred to as "喜療妥"), some people find them helpful for bruising, but results can vary. Always consult your doctor before trying new treatments.

3. Concerns about muscle fibrosis or calcification:
If a hematoma persists for an extended period without resolution, there is a risk of complications such as muscle fibrosis or myositis ossificans (calcification of muscle tissue). However, this is more likely to occur with significant trauma or prolonged immobilization. Regular movement and gentle rehabilitation exercises, as advised by your healthcare provider, can help mitigate these risks.

4. When to return for a follow-up:
If the swelling does not begin to decrease within a few weeks, or if you experience increased pain, redness, or warmth in the area, it would be prudent to return to your doctor for further evaluation. Generally, if the hematoma has not improved after 2-3 weeks, a follow-up appointment is advisable to rule out any complications.

5. Should you continue to elevate the injury?
Yes, elevating the injured leg can help reduce swelling. It is particularly effective in the first few weeks post-injury. You can continue to elevate your leg whenever you are resting or sitting, especially if you notice that swelling increases when your leg is down.

6. Is your recovery slow?
Recovery times can vary significantly based on the severity of the injury, individual healing rates, and adherence to treatment protocols. Two weeks may feel like a long time, but hematomas can take several weeks to resolve completely. Factors such as age, overall health, and the extent of the injury can all influence recovery time. If you are concerned about the pace of your recovery, discussing this with your healthcare provider can provide reassurance and guidance.

In summary, while it can be frustrating to deal with a slow recovery from a hematoma, following your doctor's advice regarding treatment and monitoring your symptoms is crucial. If you have any concerns or if your symptoms worsen, do not hesitate to seek further medical advice. Your health and recovery are the top priorities.

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