Traumatic hemarthrosis has a high association with ligamentous injury or an intraarticular fracture. Effusions following trauma may range from small to large painful ones that impede range of motion. Aspiration of very large traumatic effusions will provide pain relief and increase range of motion. Treatment of traumatic hemarthrosis consists of immobilization, ice, and elevation of the affected joint. In the absence of a fracture or significantly unstable joint requiring immediate orthopedic evaluation, follow-up is needed for possible ligamentous and articular injuries.
Spontaneous hemarthrosis usually indicates underlying systemic illness and should trigger a search for primary or secondary coagulopathies. Hemophiliacs should receive specific clotting factor replacement (see Chap.212), and their joints should generally not be aspirated. Follow-up should be provided with hematology and orthopedics.
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