2017 ISAKOS Biennial Congress ePoster #2504

 

Treatment of Developing Thigh Hematomas in Athletes: A Systematic Review

Tianyi D. Luo, MD, Winston-Salem, NC UNITED STATES
Brittany E Haws, BS, Winston-Salem, NC UNITED STATES
Ian Al'khafaji, MD, Mesa, AZ UNITED STATES
Jason P Rogers, MD, Winston-Salem, NC UNITED STATES
Michael T. Freehill, MD, FAOA, FAAOS, Redwood City, CA UNITED STATES

Wake Forest Baptist Medical Center, Winston-Salem, NC, UNITED STATES

FDA Status Not Applicable

Summary

On average, time to return to play following conservative management of a thigh hematoma is 29.3 days while comparable data for surgical management is currently unknown.

Abstract

Objective

Thigh contusion is a common injury reported in athletes. However, the optimal treatment guidelines for thigh contusions, potentially leading to hematoma, in the athletic population remain ill-defined. The objective of our study was to perform a systematic review of the literature regarding appropriate treatment and timing of nonsurgical and surgical treatment of thigh hematomas in athletes to determine an optimal treatment algorithm. Specifically, we aim to compare these treatment options with respect to time to return to sport. To our knowledge, this is the first systematic review on this topic.

Methods

A systematic review was performed by searching 2 databases. Search terms included “thigh contusion”, “thigh hematoma”, “quadriceps contusion”, “quadriceps hematoma”, “treatment”, “athlete”, and “sports.” Inclusion criteria included (1) athletes of any age that sustained thigh contusions caused by sports-related trauma, (2) data relating to treatment outcomes of thigh hematomas, (3) patient studies with level I-IV of evidence from any year of publication, and (4) studies published in English.

Results

Seven studies met our inclusion criteria and were included in this study and all were level IV evidence. Six of the studies reviewed management of the patients in a non-operative fashion and one with surgical intervention. The average time until return to play across the studies with non-operative treatment was 29.3 days (range of 2-180 days). In the lone operative series, eight patients developed compartment syndrome from thigh hematomas and underwent fasciotomy and evacuation of hematoma. Within two days following surgery, active exercises were begun and patients were mobilized on crutches for 5-7 days. Patient follow-up occurred after 2 to 6 weeks, at which time all patients were walking independently without a limp. Time to return to play, however, was not reported in the results. With respect to complications, myositis ossificans was described by four of the included studies, with a reported incidence of 35 out of 289 total cases (12.1%).

Conclusions

While thigh hematomas are common in sports, sparse literature exists regarding the appropriate timing of conservative management and when surgical intervention is warranted. On average, time to return to play following conservative management of a thigh hematoma is 29.3 days. However, it is currently unknown if operative management might provide any benefit in this respect. This information can be used as baseline expectations when non-operative treatment is employed. If an athlete fails to return to sport at the expected time, further work-up for retained hematoma with the possible need for surgical intervention should be considered.