Bone bruise

Last revised by Dr Joachim Feger on 25 Jan 2022

Bone bruises (also known as bone contusion, trabecular microfracture) are an osseous injury that results from compression of bone structures.

Bone bruises represent trabecular microfractures with hemorrhage and without a discrete fracture line or contour abnormality 4. They typically appear within 48 hours of injury and can persist for up to six months 3.

Most bone contusions are a result of a direct blow to the bone, traction from avulsion trauma, or load to a subchondral surface 1,2,5. Depending on where bone contusion is seen, the underlying trauma mechanism can be identified.

They can progress to osteochondritis dissecans 2

Plain radiography will not demonstrate cancellous features but can show regions of impaction, for example, a Hill-Sachs defect 5

MRI is the modality of choice when investigating bone marrow. Bone (marrow) contusion is typically focal and ill-defined with the following signal characteristics 4

  • T1: focal hypointense area of bone marrow
  • T2 fat-saturated: focal hyperintense area of bone marrow

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4: with hyperextension knee injury
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