Sunday, April 7, 2013

Putting back your Bones, Putting back your Life!

Basketball fans, not only in America, but throughout the world, witnessed the “gruesome” injury of Louisville guard Kevin Ware last week.  

  And since this kind of injury is one of the common injuries orthopedic surgeons deal with, allow me to discuss a few things about this.

Reports showed how the player came down wrong on his leg as he tried to block the shot of an opponent player. His right tibia, or shinbone, broke through the skin in what is called an open or compound fracture.  This caused fans and players alike to shut their eyes in horror and disbelief.  Some nearly hurled.  (Just look at the reaction of the bench of Ware’s team in the above YouTube clip.  (Napaiktad sa gulat!)
So what happens in open fractures?

Not only does the bone get broken, open fractures often cause damage to the surrounding muscles, tendons, ligaments, and more importantly, blood vessels.  The usual concern here is infection because once the skin is broken, harmful germs or bacteria may prevent the wound and the bone to heal.

I am not privy to the exact treatment that the player got, but the typical procedure for this kind of injury, is that the patient will be immediately brought to the hospital. After thoroughly cleaning the broken soft tissues (muscles, ligaments, etc), the bone will be reset and a metal rod will be inserted into the shin bone. That’s either a stainless steel or titanium placed inside the hollow leg bone to reconnect it where it broke.  After surgery, we place patients on antibiotics to lower the risk of infection.

  Although the fracture looked gruesome and extraordinary, orthopedic surgeons like me see this often, especially if you trained in a major government  hospital like PGH (Philippine General Hospital) or POC (Philippine Orthopedic Center).

     The thing here is that open fractures are usually the result of a "high-energy" trauma, such as a vehicular accident or a fall from a height. The injury was extremely unusual given the circumstance (jumping in basketball). The player may have twisted his leg as he landed, causing the bone to snap. It's possible Ware had a “stress” fracture or benign bone tumor that weakened the tibia before his fall.  This is called a ”pathologic fracture.  As I’ve mentioned, I am not involved in his care so I am just stating my own personal opinion here.

Can the player go back to playing basketball again?

A good friend of mine from High School asked me this.

My answer?

Ware’s doctors probably got him up and moving the day after surgery. And with intensive daily physical therapy, he could be back on the basketball court in six months to a year, barring any complications. In a "best-case scenario," Ware would begin to show signs of healing within 8-12 weeks. In other words, the injury is not likely a career-ending one.

However, the three most common complications for open fractures are infection, difficulty healing and a condition called acute compartment syndrome. That develops when pressure builds in the muscles surrounding the injury. This very painful and can cause tissue death if the pressure is not relieved.

If Ware's leg doesn't heal properly, he may need more surgery.

Should we be more concerned now and discourage our children from playing basketball since these injuries occur?

Before leaving the court on that fateful day, Ware reportedly told his teammates to focus on winning the game.  “Win the game.  Just win the game!”.

The gruesome injury and words apparently left his teammates in tears, and they went on to win the game.

A photo posted on the Internet shows his jubilant teammates holding up Ware's jersey as they celebrated their win. Another showed Ware in his hospital bed, holding the trophy his teammates brought to him.

So my answer to the question is NO. We should not get disheartened when injuries like these happen. Because we all know that everything happens for a reason.

Kevin Ware himself was not disheartened. Remember he was more concerned for his team to win. It can serve as an inspiration to any injured player. As a good friend of mine from Medical school commented, “If you'll pardon the expression, Ware has balls of titanium and now a leg to match”. 

      And besides, you can always call your friendly and well-trained orthopedic surgeon to put back your bones (and possibly your life) together again. 

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