The Westenders Scooter Club has many interesting and talented members, one of which is 'Doc', who is a real doctor. When he's not riding or working on his scoots or tinkering with his classic airplane, he can be found at his practice helping people feel better.
While scooterists do their best to ride safety and avoid accidents and injuries, spills and ouchies can still happen. We are privileged to be able to share the following article from Doc regarding the most common injuries experienced by scooterists, and what action you can take to minimize their impact...
(or Treatment of Traumatic Hematomas)
Over the years, as a general physician, I have treated numerous injuries, especially hematomas or bruises. They start when liquid blood escapes damaged blood vessels, as after a crush injury. Within minutes this blood begins to clot, then over the next few hours to days the clot dissolves, leaving a watery liquid with the remains of blood cells in it. This may present as a spongy area if the blood has infiltrated into tissue or as a type of cyst or liquid filled sack if the blood pooled, as in between muscles and tissue layers. If not treated correctly they can lead to chronic conditions which can be very difficult to treat. These might include chronic lymph-edema, a chronic subcutaneous mass or even expanding liquid hematomas which can dissect along or between muscle bundles and fascia planes.
Since getting back into the two wheeler scene I have unfortunately had some personal experience with fairly massive bruises and hematomas of my legs, for the most part, but also elbows and even my posterior regions as some of you regrettably know. So I thought I might pass on some tips on treatment techniques which can speed the healing process and help prevent any future complications.
The first order of business is to treat any open wounds and abrasions. After gentle but thorough cleaning with antiseptic soap solution, hydrogen peroxide or the like, close any lacerations, apply antibiotic cream such as silver sulfadiazine, mupirocin, or similar, then cover with an appropriate non-stick (ie: Telfa) dressing. Generally, re- cleaning the wound and changing the dressing once daily will provide the fastest healing and minimize infection. By the way, keeping the wound covered until the skin has grown back is best. Letting it "dry out" and form a scab will retard healing and increase risk of infection.
Next, apply firm, even pressure using an elastic (Ace) wrap or, better yet, a compression garment. This will help prevent formation of liquid filled cavities and push any ones that have already formed back into anatomic position. I suggest using the elastic wrap only as a temporary measure (hopefully no longer than a day) until the correct compression stocking or garment can be obtained. This garment should be worn until the area appears completely healed and back to normal which will usually take around 3 weeks or so.
Elevation of the injured part above the level of the heart is important. And for the first 24 to 48 hours an ice pack can be used over the wrap or compression garment. I'm sure you all know about bags of frozen peas or the like. Another tip is to fold a hand towel to a handy size, soak with water, squeezing out the excess, then seal it in a Ziploc bag. Put it in your freezer and once frozen it will make a nice, soft, moldable cool-pack. I have known moms to do the same thing with small rectangular sponges, keeping a few of them ready for their kids as "Boo-boo Packs".
For some reason my scooters have attacked my calves more than any other part of me. My most recent spill resulted in rapid development of a very large liquid hematoma over my medial calf around 5 by 8 cm and raised over 2 cm. I followed my own advice as laid out above and had my pressure stockings on within 30 minutes of the injury. By the next day the hematoma had flattened out, returning to the normal contours and has gone on to resolve rapidly.
One of my patients was not so lucky. He injured his thigh (also riding a motorcycle) causing a hematoma almost 3 times the size of mine. He didn't apply any pressure at all and about 3 weeks later came in complaining of pain and a feeling of something "sloshing" in his upper leg. It looked like someone had implanted a large bag of fluid under the skin of the inside of his entire thigh. Like a saline butt enhancement that went bad. Using a large bore needle I drained half a cup of liquid out of it and had to repeat it 2 more times during the next week. He now has to wear a compression stocking on a long term basis but it's possible he may require surgical treatment in the future.
Blood is interesting in that although it is essential for life it needs to be kept within its piping system. Otherwise, if it escapes into tissue or cavities such as the abdomen it can be extremely irritating, causing pain and a considerable inflammatory reaction. Thus in a limb you may often notice edema (along with more than usual soreness and tenderness) for a couple weeks after the injury. The compression garment will help prevent this. I have also seen chronic lymph-edema after similar injuries which have required long term, possibly lifetime, use of pressure.
Pressure garments come in all sizes and shapes for just about any area of your body. Stockings short or long, arm sleeves, torso "shirts", you name it. The better stocked pharmacies often carry a limited line as do medical supply houses. There are lots of sources on-line. They come in several levels of tightness and I would suggest moderate to firm as best for this sort of treatment.
I sincerely hope none of you ever have a hematoma to treat, but if you do these suggestions should help you get back to normal as quickly as possible. And of course you're welcome to call me anytime for more specific info.
Ride Safely!! Doc
(Robert L. Morgan, MD)
GLOSSARY
ede∙ma fm Greek oidēma swelling 1: an excess accumulation of serous fluid in connective tissue - also called dropsy.
fas∙cia 1: a sheet of connective tissue covering or binding together body structures
he∙ma∙to∙ma 1: a mass of usually clotted blood that forms in a tissue, organ or body space as a result of broken blood vessels.
lymph∙ede∙ma edema due to faulty lymphatic drainage. Usually implies chronic, acquired.
me∙di∙al 1: lying or extending in the middle; lying or extending toward the median axis of the body.
se∙rous fm Latin serum 1: of, relating to, or resembling serum; especially: of thin watery constitution.
