Simple and safe treatment of pretibial haematoma in elderly patients

Treatment of lower limb haematomas in elderly patients is complex. These patients often have multiple medical problems such as respiratory problems, cardiac problems, and arthritis. They are often taking drugs including warfarin, corticosteroids, and aspirin. Conventionally, patients with pretibial haematomas are managed under general or regional anaesthesia for evacuation of the haematoma and skin grafting if required. ¹ While the patient on the ward, waiting for results of investigations and optimising the patients general condition for surgery, the skin over the haematoma may undergo vascular compromise leading to skin necrosis and subsequent infection. The time taken for these patients to be assessed as fit for general or regional anaesthesia and for their overall condition to be optimised can compound the problem with necrosis of the overlying skin, contamination, and infection. ² The time spent may delay evacuation of the haematoma to the point where total skin loss over the haematoma results, necessitating skin grafts to the traumatised area.

Postoperatively these patients are at risk of developing deep vein thrombosis, pulmonary embolism, and other cardiovascular complications because of immobilisation. ^{3 4}

We evacuate these pretibial haematoma as soon as possible after the injury,...