Post created by Gunnar
With football season in full swing and with the memory of Cowboys quarterback Dak Prescott's compound ankle fracture fresh in our minds I thought it would be interesting to take a look back and see what other graphic leg injuries sports have produced. To do this I have enlisted the help of Jeff Fjelstul, a physical therapist and strength and conditioning specialist working at Seattle's VA hospital. We will look back at some of the most unsettling and iconic leg injuries over the past 2 decades and analyze them from an anatomical perspective to estimate recovery time. The goal of this post is to apply a knowledge of anatomy and physiology to the world of sports injuries in order to better treat and prevent future leg injuries. As health care professionals in the field of nursing, physical therapy or sports performance it is not uncommon to encounter these injuries and having a historical perspective could prove useful.
Napoleon McCallum
Injury: Anterior Cruciate Ligament (ACL) Tear, Posterior Cruciate Ligament (PCL) Tear, Lateral Collateral Ligament (LCL) Tear, Medial Collateral Ligament (MCL) Tear, Calf Muscle Tear, Hamstring Tear, Severe Nerve and Arterial damage.
Mechanism: McCallum had planted his foot and another player grabbed hold of his upper body pulling it over his planted leg creating a fulcrum at the anterior knee which hyper extended it. Because the defender grabbed his upper body rather than his hips there was enough leverage to severely break the knee joint.
Recovery: 6 surgeries and years of physical therapy, at first there was concern that the leg would have to be amputated due to the nerve damage. Although McCallum never played football again he went on to live a relatively normal life filled with swimming, running and some sports as long as he is careful.
Prevention: As will be seen with the majority of leg injuries in sports there is very little that could be done to prevent this injury. No brace would have given enough protection to stop the knee from breaking. Even rule changes could not prevent this injury because of the dynamic nature of football.
Kevin Ware
Injury: Severe Compound Tibia and Fibula Fracture
Mechanism: The mechanism in this instance is purely speculative. This injury could be the result of his very high ankle supporting shoes or an ankle brace transferring the force from his ankle to his tibia and fibula. Additionally, it is possible that he has some undiagnosed bone condition such as osteomalacia that made his bones brittle. This instance is unique in that there is no external shear force applied to the leg, he was simply absorbing the force generated from his own body weight after jumping.
Recovery: Surgery and months of physical therapy lead to Ware making a full recovery. He finished his college basketball career with Georgia State and went on to play for a professional Czech basketball team in 2016.
Prevention: The term “freak injury” tends to be thrown around quite regularly, however, this truly is a freak injury. The simple jump that caused this injury happens thousands of times in an NBA season and players almost never have this injury. Basketball is not a sport that is generally associated with tibial fractures but in the world of sports anything is possible.
Anderson Silva
Injury: Compound Tibia and Fibula Fracture
Mechanism: Anderson Silva threw a leg kick intending to hit the inside of Chris Wideman’s thigh to cause bruising and immobility. However, when Wideman raised his leg to block the kick the diaphysis of Silva’s tibia collided with Weideman's tibial tuberosity. Because the tibial tuberosity contains more compact bone than the diaphysis of the tibia or fibula it was able to not only withstand the impact of the kick but break Silva’s tibia and fibula.
Recovery: Surgically inserted titanium rod allowed bone to grow back correctly followed by a 2 year hiatus and extensive physical therapy. Anderson Silva has fought 7 times since the injury and has gone 1-5-1 in those 7 fights. Silva’s last fight was on October 31st of this year, where he retired after being KO’d in the 4th round.
Prevention: Modern MMA has shifted away from the thigh kick and more to the calf kick in recent years and this fight may have helped cause that shift. If Silva had targeted the calf, not only would he have minimized the risk of his kick being blocked but he also would have the potential to inflict more damage as there is less tissue to protect the calf. Because a calf kick is already aimed lower than your opponent's tibial tuberosity there is minimal risk that your opponent could block the kick in this fashion.
Joe Theismann
Injury: Compound Fracture of the Tibia and Fibula
Mechanism: This injury is very similar to Dak Prescott's injury where one player's body weight is applied as shear force to the side of another player's planted lower leg, The difference here is that the defender landed much higher on his leg sparing him from an ankle dislocation.
Recovery: Surgery and Physical Therapy, he attempted to return about a year later but failed his physical and got cut from his team. He went on to have a successful career as a broadcaster.
Prevention: Football is a very dynamic sport and no matter how careful players are or how conservative the rules become there is always the potential for freak injuries. There is no protective equipment that could have stopped his leg from breaking.
Dak Prescott
Injury: Compound Tibia and Fibula fracture, Dislocated Ankle
Mechanism: The tibia and fibula are designed to absorb longitudinal stress but are not well designed to withstand lateral shear forces. Additionally, the ankle joint (talocrural) is designed for dorsiflexion and plantar flexion but is not well suited to absorb a lateral shear force. When Prescott’s foot was planted to the ground his opponent applied a lateral shear force with most of his body weight behind it. This dislocated the talus in the mortice fracturing the distal ends of the tibia and fibula which form the lateral walls of the talocrural joint.
Recovery: This will require surgical repair and years of physical therapy. Because he is a quarter back it is possible he will be able to return to the sport, this would be far less likely if he played a position that placed a greater emphasis on running such as a running back or receiver.
Prevention: Unfortunately the only sure fire way to avoid this injury is to avoid contact sports all together. If an athlete were to wear an ankle brace that could prevent the forces of this impact from breaking his ankle, the force would have been transferred to the knee causing a severe sprain. No matter how much protective gear athletes wear and no matter how careful they are on the field some freak incidents will still occur.