bad breaks

Monday, April 1, 2013

Watching elite athletes perform on the playing field is meant to inspire. Like listening to a gifted musician or watching an actor on stage, live performance creates a bond between performer and fan. However, the stage rarely moves and there are no body checks or fouls at a symphony. Not only does an athlete have to prepare for the physical and mental challenges of competition but also needs to overcome the roadblocks placed by the opposition. It is the small movements, barely perceptible, that allows an athlete to stay balanced, shift a center of gravity and adjust footing that prevents falls and injury. Muscles, tendons and ligaments stabilize the body and prevent potential injury and damage. Sometimes, those mechanisms fail, gravity and physics collide with the forces being placed on a leg or a joint and disaster occurs. A hush falls over the crowd, the cameras turn away and medical people rush onto the court.

Kevin Ware, guard for the Louisville Cardinal, had jumped to block a shot thousands of times in practice and in a game. Landing on one foot or two, twisting away or turning into an opponent was an instinctive act, not requiring thought, just body reaction. But in front of a packed house and millions more watching on television and the internet, Mr. Ware acme down on one leg with just the right (or wrong) angle, torque and amount of force that the leg gave way and the crowd hushed. The leg is not meant to bend at such an awkward angle and the bone is not meant to be pushed through the skin. Disaster had struck.

Even to the non-medical, the injury looked devastating even without x-ray. Some of the potential problems:

  • This was an open fracture, meaning the skin had been torn and the bone exposed to the outside world. That world is not very clean and the sterile inside of a bone is not meant to be in contact with it. The risk of bone infection, or osteomyelitis is a major complication of preventing that infection is paramount.
  • The fracture was displaced. Then bones were shifted out of alignment. The muscles, arteries, veins and nerves are stretched running the risk of their damage and potential malfunction. Reducing the fracture quickly will decrease the tension of vital structures but that may be tough. Pulling the bone out to length is more than a little painful and the bone sticking through the skin can get stuck.
  • Those muscles don’t like being damaged and can gradually swell. In the lower leg, there are four compartments where the muscles are located and should enough swelling occur, the pressure within can be high enough to cut off circulation…the potential disaster called compartment syndrome.

Mr. Ware was taken quickly to the operating room where his leg was washed out and the decision made to repair the bones immediately. This is where the art of surgery comes together with the science. The surgeon has to decide if the bone is clean enough to allow metal hardware to be inserted right away or whether the wound is still too dirty and a second operation planned to fix the bone. The decision is made in the OR, based on experience and gestalt. The stakes are high. If the plates, screw, rods, pins and any other carpentry hardware used to put bones together gets infected, it likely means all that stuff has to be removed and the whole repair process started again.

The goal of any surgery is to return the player to their previous level of competition and function. Once Mr. Ware clears the hurdles of the early post-operative period with the risk of infection, blood clots and swelling, he has the new challenge of rehabilitation. In the coming months, there will be few crowds cheering, just teammates and coaches giving encouragement. There will be quiet as he spends hours with physical therapists and on his own, getting back range of motion power in the leg.

Mr. Ware has a new goal to return to the stage, connect with the fans and compete at an elite level. For the fans, it is another lesson learned. The thrill of victory is sometimes dampened by the agony of injury.

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