agony of defeat…tib fib fractures

Sunday, August 7, 2016

The public seems to have a morbid curiosity about trauma. While major injury makes us turn way and not want to look when an athlete gets hurt, it’s that same injury that gets millions of view on Twitter and YouTube. Tib-fib fractures seem to be immensely fascinating, given the long term popularity of Joe Theismann’s broken, injured while playing for the Redskins in 1985.

French gymnast, Samir Ait Said, suffered the same injury during the vault in Rio. A collective groan could be heard in the arena, as could the snap of the bones…and the clicks making him trend on Twitter.

tibfib fracture

  • The initial injury may seem gruesome, but it is the potential complications that may be even worse. This is especially true for tibia and fibula fractures, similar to Thiesmann’s and Said’s. The skin overlying the shin is very thin and with the force of the injury, it is not uncommon for the overlying skin to be cut, torn, lacerated…choose a word. The old term “compound” has been replaced with “open” which describes the fact that the inside of the bone is now exposed to the outside world and the risk of bone infection increases dramatically.
  • The muscles that surround the tibia and fibula are encased in four tight compartments and with an injury like a broken leg, bleeding and swelling can increase the pressure within one, many or all of the compartments. If the pressure inside a compartment increases higher than venous pressure, blood cannot flow back to the heart and swelling starts to occur, increasing the pressure even further. If the pressure is not released by fileting open the compartment, muscle and nerve tissue dies and badness ensues. Up to 10 percent of midshaft tibia fractures may have an associated compartment injury.
  • Other complications that can occur in the next few days include nerve damage, (the peroneal nerve is often the target when the fibular head is damaged and leads to foot drop), skin sloughing because of poor blood supply to the front of the shin, and leg amputation if the fracture repair is delayed. Because both bones are broken, the leg is unstable and can flop around if not immobilized. This can stretch or tear the arteries that are heading to the ankle and foot causing loss of blood supply, a bad thing. Knee dislocations are associated with artery injury and often, the diagnosis may be initially missed because the knee often relocates before it is evaluated by medical personnel.
  • And long term, non-union of the fracture may occur. The tibia is the most common bone to refuse to heal, leading to repeated surgeries. It’s all about get blood supply to the area of injury, so that the body can deliver the building blocks needed to reconstruct the bone. This is a design flaw of the body that leads to poor blood supply and poor healing. Unfortunately, it’s not the only place where the body was not engineered to supply blood to broken bones. Scaphoid fractures in the wrist are another example.

BBC Gets It Right

While Mr. Said lay on the ground, attended by trainers and doctors, the internet started to exploit the injury, giving those who have a fascination with pain and suffering the opportunity to watch replays of the injury. Twitter, YouTube,Facebook and numerous news websites posted videos and photos of the injury. While NBC’s website displays a warning about graphic images, perhaps BBC understands that most people do not want to be “entertained” by such misery. Their reporting ends with the following:

“Highlights footage and photos of the injury are too graphic to be shown on the BBC Sport website.”

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One Response to agony of defeat…tib fib fractures

  1. […] Almost all fractures have the potential for damage to an artery or nerve. Finding the break is just the first step in assessing the patient. Knowing anatomy helps look for the second injury. The radial nerve wraps around the humerus in the upper arm. Break that bone and the nerve may stop working, leading to wrist drop, weak grasp and hand numbness. Wrist fractures can affect the carpal tunnel where the median nerve runs. Dislocated knees can cause damage to the popliteal artery and potential loss of blood supply to the leg. There is always a second step in even the most routine injuries to assess circulation (blood flow) and nerve function (movement, power and sensation). That second step may have to be repeated more than once, because swelling that develops over time can wreak havoc causing problems like compartment syndrome. […]

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