On the fourth day after ORIF for a hip fracture, a patient develops a large ecchymosis over the unaffected hip. This most likely indicates which of the following?

On the fourth day after ORIF for a hip fracture, a patient develops a large ecchymosis over the unaffected hip. This most likely indicates which of the following?

• A. Hemangioma
• B. Complication of anticoagulant therapy
• C. Hematocele
• D. Deep vein thrombophlebitis

Answer: (B)

Bleeding risk from anticoagulants used after hip fracture surgery is what this finding points to. After ORIF, patients commonly receive anticoagulant therapy to prevent DVT. These drugs impair clot formation, so widespread or easy bleeding into tissues can occur, showing up as large ecchymosis away from the operative site. The bruising on the unaffected hip reflects a systemic effect of anticoagulation rather than a localized collection at the surgical wound. Other options don’t fit the pattern. A hemangioma is a benign vascular lesion and wouldn’t present acutely with new postoperative bruising. A hematocele would be a collection of blood within a body cavity (often scrotal in males) and isn’t the typical cause of a new ecchymosis on the hip. Deep vein thrombophlebitis causes leg swelling, warmth, and tenderness rather than extensive contralateral ecchymosis.

Bleeding risk from anticoagulants used after hip fracture surgery is what this finding points to. After ORIF, patients commonly receive anticoagulant therapy to prevent DVT. These drugs impair clot formation, so widespread or easy bleeding into tissues can occur, showing up as large ecchymosis away from the operative site. The bruising on the unaffected hip reflects a systemic effect of anticoagulation rather than a localized collection at the surgical wound.

Other options don’t fit the pattern. A hemangioma is a benign vascular lesion and wouldn’t present acutely with new postoperative bruising. A hematocele would be a collection of blood within a body cavity (often scrotal in males) and isn’t the typical cause of a new ecchymosis on the hip. Deep vein thrombophlebitis causes leg swelling, warmth, and tenderness rather than extensive contralateral ecchymosis.