Paul George breaks leg...

[orange79]

I don't think the NBA has anything to do with this. I could be wrong though. Maybe he sues USA Basketball?

Yeah, you're right. Brain fart

 

[suttree]

Mother of god...

That video clip is BRUTAL.

Mother of God. I really wish I'd followed my initial instincts (and the warnings here) and not watched that. Horrifying.

 

[HOFCeluck]

Hey can someone tell me what a "clean" break is? You mean vs like a green stick fracture? Simple vs comminuted vs open? It reminds me of when people are told they have a broken bone and they say "oh I thought it was a fracture."

 

[orange79]

Hey can someone tell me what a "clean" break is? You mean vs like a green stick fracture? Simple vs comminuted vs open? It reminds me of when people are told they have a broken bone and they say "oh I thought it was a fracture."

I guess by 'clean', I meant little to no splintering; one that could be set and would heal 'easily' ( and not requiring multiple operations). I'm not a doctor, but I did stay at a Holiday Inn Express last night.

 

[HOFCeluck]

I guess by 'clean', I meant little to no splintering; one that could be set and would heal 'easily' ( and not requiring multiple operations). I'm not a doctor, but I did stay at a Holiday Inn Express last night.

Oh ok, thanks.

A tibia fracture in an adult is pretty much an automatic surgery. If it's around the middle of the bone a long rod that runs thought the center of the bone is used. In a relatively low energy injury like this (as opposed to say a car accident) in a guy like Paul George it should heal with just that no problem.

What makes it more complicated is if the bone is actually going through the skin. The chances of the bone getting infected or of the bone not healing get higher.

 

[TOL22]

WARNING:

https://vine.co/v/MEVQBYqivLw

-- I am so stupid

 

[realorange]

Out for the year.

 

[STEVEHOLT]

As bad as it looked it's better than tearing your ACL.

you have no way of knowing that. nobody does. odds are that he will be fine eventually, but ill take the acl tear as there is a much greater track record of players doing well after that surgery than there is in people recovering from this type of fracture because its just that rare in sports.

 

[STEVEHOLT]

i wonder if there is someone that will devise a brace type device that will add tensile strength to the tibia/fibular region to prevent this type of injury from occurring? I mean this is not a joint so you as long as it doesnt limit motion at the knee or the ankle, one would think it could be done..maybe something made out of kevlar that you wear like a compression stocking? just spit balling here. i would think football players would interested in such a device even more so than b ballers.

 

[The Governor]

you have no way of knowing that. nobody does. odds are that he will be fine eventually, but ill take the acl tear as there is a much greater track record of players doing well after that surgery than there is in people recovering from this type of fracture because its just that rare in sports.

It was a clean break on a broken leg, that's hardly rare and definitely not worse than a torn ligament for a 24 year old man in 2014. He'll be back to his old form when his leg heals and he'll have almost no chance of re-injuring it, soft tissue are a different story.

 

[HOFCeluck]

It was a clean break on a broken leg, that's hardly rare and definitely not worse than a torn ligament for a 24 year old man in 2014. He'll be back to his old form when his leg heals and he'll have almost no chance of re-injuring it, soft tissue are a different story.

It's an open tibia fracture. The potential complications are far worse than an ACL tear.

 

[HOFCeluck]

i wonder if there is someone that will devise a brace type device that will add tensile strength to the tibia/fibular region to prevent this type of injury from occurring? I mean this is not a joint so you as long as it doesnt limit motion at the knee or the ankle, one would think it could be done..maybe something made out of kevlar that you wear like a compression stocking? just spit balling here. i would think football players would interested in such a device even more so than b ballers.

I would think that would put more stress on the knee and ankle.

 

[MCC]

As this was an open fracture the risk of infection (esp. osteomyelitis) is higher. Osteomyelitis is a bitch to get rid of and pts often require a chest port to deliver IV abx for 4+ months. Also note that there may be damage to surrounding tissues - if anything happens to the peroneal nerve you can end up with drop foot, which means you can't dorsiflex (lift) or evert (turn outward) your foot. The peroneal can reennervate but if it doesn't you end up with a real loss of fine motor control. While you can do a tibial tendon transfer it'll never be quite the same. Severe knee injuries are a more common cause of drop foot (see Jay Williams; his peroneal did reennervate over time) but you can see it with proximal tibial frx. While rare, compartment syndrome can occur after fractures like this; the resulting decrease in blood flow reduces oxygen delivered to nerve and muscle alike - can really complicate the healing process and leave him with less function post recovery. He'd also need another surgery to open up the fascia.

Didn't look like a comminuted fracture; appeared to be compound oblique tib fib frx.

He'll have a titanium rod (called an intermedullary nail) slotted in his tibia and locking screws placed near the proximal and distal end of the bone. The IM rod will stay in until he's done healing, then it becomes a decoration - most likely it'll be taken back out.

Since he's not a multitrauma (e.g. car accident) you'd think he'll heal fine without the need for rBMP-1 (recombinant bone morphogenic protein). In pts who aren't healing well you may need to go to rBMP-1 and an autologous bone graft where you take a few a few chips from the hip area (iliac crest) of the pts pubis.

Finally, the fibular frx will likely just be reduced (repositioned into the right alignment) when they do ORIF on the tibial frx - the fib doesn't support much weight and often they don't need to put screws in. The exception is frx near the ankle (malleolar frx) where you can have significant instability.

Hard to say where he'll end up 12+ months from now. Any nerve damage, compartment syndrome, or osteomyelitis would really complicate matters and extend his recovery. If he heals "clean" he could certainly play again.

 

[MSOrange]

As this was an open fracture the risk of infection (esp. osteomyelitis) is higher. Osteomyelitis is a bitch to get rid of and pts often require a chest port to deliver IV abx for 4+ months.

Very good post. This part really hit home for me. I got a wound from sitting in my wheelchair and it eventually turned into MRSA and osteomyelitis. To make a long story short, the whole ordeal ended up lasting over 2 years from beginning to end. I wouldn't wish that on anyone and that was my first thought with an open fracture.

 

[CuseFaninVT]

I would think that would put more stress on the knee and ankle.

I was thinking the same thing. Imagine all that force pushed to the knee and ankle instead. Major damage.

 

[MCC]

I was thinking the same thing. Imagine all that force pushed to the knee and ankle instead. Major damage.

Yup. Complex ankle frx are atrocious. There's also a good possibility you'll lose a ton of blood. It's really challenging to set things like trimalleolar frxs or syndesmotic injuries with bone involvement right again.