fracture times three: the shoulder, the back and the ankle

Tuesday, November 4, 2014

In the past few days, what we’ve learned from football is that not all fractures are created equally. From Nick Foles’ collarbone to Laquon Treadwell’s ankle and Tony Romo’s back, all broken bones are not the same and the approach to treatment is tailored to not only the bone but also to where in the bone the damage has occurred and what surrounding structures are damaged. Perhaps the first lesson is a reminder that broken, fractured, cracked all mean the same thing. One word does not make an injury more or less significant. It’s uncomfortable to watch the replay of an injury but those slow motion images can help explain the mechanism of injury and the stress that is put on the skeleton of the body.

Eagle quarterback Nick Foles was sacked and as he was being tackled and taken to the ground, lands directly on the point of his shoulder. This force of the fall is transmitted to the clavicle or collarbone and can cause the fracture or a separated shoulder where the AC (acromio- clavicular) joint is torn. The damage depends upon which structure cannot withstand the force applied. For Mr. Foles, his collarbone injury will be allowed to heal without surgery since the bone is not displaced, meaning that it aligns reasonably well and nature will fix it over time. That will take weeks and cannot be rushed. Last year, Aaron Rodgers same injury took a little less than two months to recover and return to play.

ac joint

For Dallas’ Tony Romo, a knee to the back caused the psoas muscle to go into spasm. The force of that spasm avulsed or tore off the transverse processes of two vertebrae in his lumbar spine. Muscles and tendons attach to bone to help support and move the body. In Mr. Romo’s case, the muscle attachments were stronger than bone and when the injury occurred, the tendon didn’t tear which would be a strain, instead, the bone tore away. The purpose of eh back, aside from allowing the body to be erect, is to protect the spinal cord and when the words broken vertebrae are spoken, the fear is that there is damage to the cord or the nerves. In this situation, the injury is far removed anatomically and functionally from the spine canal and while painful, is treated like a contusion or bruise. Return to play happens when the muscle spasm and pain can be control to allow the player to run, twist and bend over.

psoasTP fracture

Psoas muscle insertion                                  Transverse process fractures

 

 

Ole Miss receiver Laquon Treadwell is not as lucky. A twisting injury to his leg cause a fracture dislocation of the ankle and is a reminder that the body cannot easily tolerate a torsion or twisting force. As he reached for the end zone, Mr. Treadwell’s lower leg was caught up in the pile. Not only did his fibula fracture but the ligaments that held his ankle stable were torn (a sprain). The tibia and fibula that connect the knee to the ankle form a circle and like trying to breaking a pretzel in just one place, a twist will always have two injury sites. In the ankle, it is either two bones or one bone and a ligament that give way. Either way, the stability of the ankle joint is compromised and the muscles that cross the joint cause it to dislocate. In most cases, surgery is required to stabilize the bone and fix the ligament to keep everything in place to allow healing to occur.

ankle ankle dislocation

 

Three fractures, three different mechanisms of injury, three different treatments and three different healing times. It’s a reminder that the body does a good job of self-healing but sometimes it needs a little help. The bottom line is that like in real estate, the key to injury diagnosis, treatment and outcome has to do with location. Understanding the mechanism and anatomy can help decide what treatment will best help Mother Nature repair the body.

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