Patriot's tight end, Rob Gronkowski, suffered from a high ankle sprain.  How effective will he be in the Super Bowl?  

Ankle sprains are very common injuries.  In the US alone, approximately 25,000 ankle sprains occur every day.  Not all of these individuals seek medical care.  Most walk it off and resume life with little or no consequences.  The question is when should you be concerned that you have a serious ankle sprain or something worse and see a doctor.   I will get to this question later in the blog.

ANATOMY

Most people sprain their ankle with an inversion type injury.  This is where the foot rolls in and the ankle rolls out.  This stretches and may tear the ligaments on the outer part of the ankle.  Outer ligaments of the ankle are always injured in the common ankle sprain.

However, in severe cases, the ligaments on the inner part of the ankle (medial ankle sprain) or between the ankle bones (high ankle sprain) can be injured.  The medial sprain will be a topic for future blogs.

A high ankle sprain occurs when the ankle rolls out to the point where the ligaments between the fibula (outer leg bone) and the tibia (inner leg bone) tear.  This ligament structure is known as the syndesmosis.   This can be a stable or unstable injury.  If the ligament is stretched or strained, the ankle is usually stable and does not require surgery.  If the ligament is fully torn, the ankle is unstable.  This injury pattern requires surgery.

Below is an xray of an individual with an unstable syndesmosis tear.

SYMPTOMS

When an individual has a high ankle sprain, walking and jumping on the injured ankle is difficult.  One may experience pain, swelling, bruising, weakness and even a black and blue mark.  Usually people have some level of pain with motion of the ankle.  Rest, ice, elevation, an ace wrap and antiinflammatories can help relieve some of these symptoms.  But if you suspect a high ankle sprain, you should see a physician sooner than later.

TREATMENTS

Initially, after a high ankle sprain, rest, ice, elevation, an ace wrap and antiinflammatories can help relieve some of these symptoms.  If xrays suggest a stable high ankle sprain, the patient is placed in a boot or short leg cast.  The individual is nonweightbearing (not allowed to placed any weight on the injured ankle) for 4 to 6 weeks.

If the syndesmosis is torn, surgery is needed.  In the operation, the tibia and fibula are put back in their proper position and held in place with screws or a device called a tightrope (see xrays).  These patients are not allowed to put weight on the ankle for 3 months.  

In either injury pattern, physical therapy is necessary to help regain range of motion and strength of the ankle.  Physical therapy has been shown in the medical literature to be very beneficial in preventing what is known as “chronic ankle pain”.  Some physicians may want you to use an ankle brace for a short period of time, while others may not want you to use one at all.  Rarely is surgery needed.

OUTCOMES

Most individuals with high ankle sprains are able to return to their lifestyles and activities after 6 to 8 weeks and a lot of therapy.  Being the Super Bowl, Gronkowski will play.  The question is how effective will be.  Just as Ben Roethlisberger's level of play decreased with this injury, it is likely that Gronkowski's will suffer as well.  Cutting, pushing off defenders, and blocking will all be problematic for him.  

VIDEO/ANIMATIONS

Dr. P

---------------------------------------------------------------------------------

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.

In the first quarter of today's game, Dallas Cowboys Quarterback, Tony Romo was knocked out of the game with a right hand injury.  He is on the sideline with a tight wrap.  Pictures show a highly swollen hand.  Will he play next week?

ANATOMY

The hand is made up of 27 bones.  In each finger there are 3 phalanges, whereas the thumb has 2.  In the palm of the hand, corresponding to each finger is a metacarpal.  In the wrist there are an additional 8 bones.  These bones work in concert to allow motion and stability to the hand. 

Michael Vick reportedly is suffering from a “hand” fracture.  It is unclear which exact bone is injured, however the fact that a CT scan is being ordered suggests that the base of one of the metacarpals, or perhaps one of the wrist bones was fractured. 

CAUSES

A fracture of the hand is usually caused by a trauma.  This can be in the form of sporting activities where something or someone crushes the hand or drops or twists on the hand. A punch, a fall on an outstretched hand, or even a gunshot can lead to a fracture of the hand. 

SYMPTOMS

Individuals who break their hand will have pain, swelling, loss of motion, and bruising. Depending on the location and position of the break, the finger may turn one way or the other when the fingers are flexed.  This is one of the reasons for surgery. 

WHEN TO SEEK MEDICAL CARE

If you suspect that you are suffering from a broken hand, you should seek medical attention within a week of the injury, A physical exam and x-rays are usually performed. A CT scan at times may be needed.

TREATMENT

Many hand fractures can be treated without surgery.  If one metacarpal is fractured, oftentimes a removable brace or splint can be worn for about 4 weeks.  If two or more metacarpals are fractured, but are located in the correct position, a short arm cast can be worn for 4 to 8 weeks. 

Surgery is considered if multiple metacarpals are broken, if the break is in the base of the metacarpal where it interacts with the wrist bones, if there is shortening of the metacarpal bone, or if one of the wrist bones is fractured.  Surgery can be as simple as the placement of 1 or 2 wires into the bone, holding it where it belongs, to placing plates and screws on the bone.  In any of these surgical situations, pressure is usually not allowed through the hand for 4 to 8 weeks.

OUTCOMES

Most athletes with a hand fracture have no long lasting issues.

RETURN TO ACTIVITIES

From the current reports, it is unclear of the nature of Romo's injury.  Given that this is his dominant, throwing hand, if a metacarpal is fractured it could be a big deal. A CT scan may be needed to evaluate the injury further.  If broken, he could be out next week.

VIDEO/ANIMATIONS

Dr. P

---------------------------------------------------------------------------------

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

New Jersey Nets Center, Brook Lopez has a Jones fracture.  When will he return to this already shortened season?

ANATOMY

The metatarsal are a series of bones in the foot that lead to the toes.  There are five metatarsal in each foot, correlating to the five toes.  The fifth metatarsal interacts with the fifth or pinky toe.  This bone is particularly important, as breaks at the base of this bone can be difficult to heal. 

To understand breaks of the fifth metatarsal, one needs to know the type of break present.  The breaks at the base of the fifth metatarsal are divided into three types:

Type 1 – an avulsion break off the base of the fifth metatarsal. This break usually heals with little problem. 

Type 2 (also known as a Jones Fracture) – a break of the base of the 5^th metatarsal that goes into the area where the 4^th and 5^th metatarsal interact with one another.  This fracture is difficult to treat, as the blood supply to this area of the 5^th metatarsal is poor. 

Type 3 (also known as a Dancer’s fracture) – a break of the long shaft of the 5^th metatarsal.

CAUSES

Fractures of the base of the 5^th metatarsal occur when the ankle is twisted in inversion, or the ankle rolls outward.  Extra pressure is placed on the base of the 5^th metatarsal, causing it to break.

SYMPTOMS

A person who breaks their 5^th metatarsal may have pain at the base of the bone, with swelling pain, and possible difficulty with walking.

WHEN TO SEEK MEDICAL CARE

If you suspect that you have a 5^th metatarsal fracture, you should see an orthopaedic surgeon.  They will require a thorough physical exam and x-rays will be needed to determine where the break is located.

TREATMENT

Treatment varies depending on the location of the 5^th metatarsal fracture and the type of break present.

Type 1 – an avulsion break off the base of the fifth metatarsal. This break usually heals with little problem. It usually requires a boot and walking cast for 4 weeks.

Type 2 (also known as a Jones Fracture) – a break of the base of the 5^th metatarsal that goes into the area where the 4^th and 5^th metatarsal interact with one another.  This fracture is difficult to treat, as the blood supply to this area of the 5^th metatarsal is poor.  The break can be treated with a cast or surgery. For those patients who decide to have a cast, they may be non-weight bearing on the injured leg for 12 or more weeks.  There is approximately a 20% non healing rate of this fracture, when treated without surgery.  With surgery, the patient is usually allowed to wear protective boots or insoles and walk 4 weeks following surgery.  In surgery, a screw or plate with screws can be used to span the break and hold the pieces together.

Type 3 (also known as a Dancer’s fracture) – a break of the long shaft of the 5^th metatarsal, This break can be treated in a non-weight bearing cast for approximately 6-8 weeks.  It requires surgery if it has moved out of place, or is not positioned correctly.

OUTCOMES

Most patients with 5^th metatarsal fractures are able to return to play.  For type 1 and 3 breaks, return to competitive sports may take 3-4 months.  For type 2 breaks, return to competitive play occurs 6-8 weeks after the surgery.

RETURN TO ACTIVITIES

Depending on the type of fracture Lopez has sustained, he should be back to football in 6-8 weeks.

VIDEO/ANIMATIONS

A live surgical video can be seen at: http://www.youtube.com/NCOCatDuke

Dr. P

---------------------------------------------------------------------------------

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

Cowboys DeMarco Murray was hurt in tonights game against the Giants.  He has an ankle fracture and a high ankle sprain.  He was immediately taken out of the game.  What does this mean for his season?   

ANATOMY

The ankle is made up of three bones: the fibula (on the outer part of the ankle), the tibia (on the inner part of the ankle), and the talus (on the central part of the ankle).  Between the tibia and fibula, at the level of the ankle joint, is a ligament which holds these one together, called the syndesmosis.  

Any of these structures can be injured in an ankle fracture/break.  Typically, the fibula is fractured.  At the same time, the tibia can be broken and/or the syndesmosis can be torn. 

CAUSES

The ankle can break with any type of trauma that causes excessive energy to go through the ankle.  The energy can break 1, 2, or more bones.  Typically, the ankle breaks with a twisting mechanism, when the ankle "rolls", or if one trips and falls.  Occasionally, a direct blow to the ankle or the heel can break the ankle.

SYMPTOMS

A person who breaks their ankle usually experiences immediate pain and swelling.  A pop or crack may be heard or felt.  The ankle will get black and blue.  Often times, the person will not be able to walk on the broken ankle.

WHEN TO SEEK MEDICAL CARE

If you suspect that you have an ankle fracture, you should seek medical attention within hours of the injury. A thorough physical exam and xrays will be needed to find out if you have an ankle fracture and the type of fracture you may have.

TREATMENT

Treatment varies depending on the severity of the ankle fracture.  If the fibula has broken, but has not shifted, a non-weight bearing cast may be worn for 8-10 weeks.  If the fibula is fractured and shifted out of place or the tibia is fractured or the syndesmosis is torn, then surgery may be necessary.  In the operating room, an orthopaedic surgeon will usually place a plate and screws in the fibula, screws or a plate in the medial malleolus part of the tibia, and/or screws or a similar device across the syndesmosis.  This allows for the broken bones and ligament to be held in place while the bones and/or ligament heals.  If the syndesmosis is torn, the patient is not allowed to put weight on the foot and ankle for 3 months.  If the syndesmosis is not torn, then the patient is not allowed to put weight on the foot and ankle for approximately 6-10 weeks.  

Below are representations of a type of ankle fracture where the fibula and the syndesmosis were torn and needed to be repaired.

OUTCOMES

Most patients with ankle fractures are able to return to their pre-injury activities with little or no difficulties.  However, there are some long-term implications of this injury.  First, about 30% of the time a "pot-hole" can develop in the ankle at the time of the injury.  This can lead to long-term pain.  Second, the cartilage is damaged at the time of injury.  This causes the development of post-traumatic arthritis in the ankle at a faster rate than an ankle that has never been broken.  Third, many patients will have stiffness and loss of motion following the injury.  Finally, extensive physical therapy is required to regain as much motion and strength in the ankle.

RETURN TO ACTIVITIES

Depending on the type of ankle fracture that Murray has, he will be out of football for at least 8 weeks.  If his syndesmosis is also torn, he will be out for 12 weeks.

VIDEO/ANIMATIONS

Dr. P

 ----------------------------------------------------------------------------------------------All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

The Houston Texan have faced another blow at the quarterback position.  Matt Leinart injured his left collarbone on Sunday and is out for the season. 

ANATOMY

The shoulder is made up of three bones: the humerus (arm bone), the scapula (shoulder blade), and the clavicle (collar bone).   The clavicle is a long, skinny bone, which is shaped as an “s”, as it travels from the sternum (breast bone) to the shoulder. 

CAUSES

Clavicle fractures are common, occurring usually in children and athletes.  The clavicle can break with a direct blow to the bone. This can occur from a blow to the front or outer part of the clavicle.

SYMPTOMS

Individuals with a broken collarbone will have immediate pain swelling and perhaps a black and blue mark.  The shoulder and arm will be difficult to move.  There may be an abnormal bump in the location where the bone is broken.   An x-ray is usually needed to get a better idea of the location and “shift” (displacement) of the break.  A good physical exam will be needed to ensure that the blood vessels and nerves that travel near the clavicle are not damaged. 

TREATMENTS

Depending on the location of the break, the clavicle can be treated with or without surgery.  In the non surgical option, the arm is kept in a sling, in order to rest the shoulder. The patient is allowed to come out of the sling every few hours to do some basic range of motion exercises and keep the shoulder from stiffening.  The bone will take 8 to 10 weeks to heal.  Surgery is selected if: the bone is pushing up too much on the skin, the broken area of bone is very tender, or in the case of an athlete.  There are a variety of ways to treat clavicle fractures with surgery, including the application of a plate and screws or a screw or device that goes in the center of the bone and stabilizes the break. The advantage of surgery is that physical therapy and exercises can begin more quickly. 

WHEN TO SEEK MEDICAL CARE

If you suspect that you have sustained a clavicle fracture or break of your collarbone, you should seek medical attention within a few hours to days.

RETURN TO ACTIVITIES/OUTCOMES

Most throwing athletes treated without surgery will be out of throwing activities for 8 to 10 weeks.  With surgery, this can be shortened to 6 to 8 weeks.

VIDEO/ANIMATION

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

Jay Cutler, quarterback for the Chicago Bears, underwent surgery today for a Bennet’s fracture or break on his throwing thumb.  What is this injury?  Can he make it back to play this season?

ANATOMY

The human hand is composed of 27 bones.   These bones are grouped into categories:  the carpal, metacarpal, and phalanges.  The human hand has five metacarpals. 

A Bennett’s fracture is a break at the base of the metacarpal of the thumb.  

This injury is usually accompanied by a dislocation or a subluxation (partial dislocation) of the thumb.  This injury makes the thumb unstable, particularly for gripping activities, such as holding a football.

There are a number of strong ligaments and tendons that attach to the smaller piece of bone that is broken. 

CAUSES

The most common causes of Bennett’s fractures are: a punch or a direct blow against a football helmet or skull, or a fall, particularly while holding a handle bar of a bike or motorcycle.

SYMPTOMS

Athletes with a Bennett’s fracture will have pain at the base of the thumb.  There will be instability of the thumb with gripping or pinching motions.   There will be weakness with these activities as well. There will be pain, swelling and bruising around the base of the thumb.

TREATMENTS

Athletes with a Bennett’s fracture will require surgery.  Surgery can be performed in a variety of manners:  with small incisions and screws, with screws and plates, or with pins alone.  If the smaller piece is very small and not out of place, a “thumb” spica cast can be placed for non surgical treatment.  Whether surgical or non surgical treatment is performed, a cast for 4-6 weeks is needed.

WHEN TO SEEK MEDICAL CARE

If you suspect that you have a Bennett’s fracture, you should seek medical care within hours of the injury.  A good physical exam, x-rays, and perhaps a CT scan or MRI may be needed to evaluate the hand.

RETURN TO ACTIVITIES/OUTCOMES

Regardless of the type of treatment, a cast is needed for 4-6 weeks.  Thereafter, physical therapy and rehabilitation is required.  It is usually 6 to 8 weeks before throwing activities can be started without pain.

If lucky, Cutler may be able to return late this season, especially if the Bears make is deep into the playoffs. 

Dr. P

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

Sunday, during the win over the Tampa Bay Buccaneers, the Houston Texan quarterback, Matt Schaub, injured his foot.  Today it was discovered that he sustained a Lisfranc injury.  What is the Lisfranc injury and why will Schaub be out for the entire remaining season?

Red Sox pitcher, John Lackey, will undergo Tommy John surgery.  What is this and what does it mean for his career?

ANATOMY

The elbow is a hinged joint, with many structural supports on the inner and outer parts of the joint.  Three bones make up the elbow joint:  the humerus (upper arm bone), the ulna (a forearm bone), and the radius (another forearm bone).

On the inner aspect of the elbow, the medial or ulnar collateral ligament (UCL), gives stability to the elbow.  On the outer part of the elbow, the lateral or radial collateral ligament (RCL) and annular ligament provide stability for the elbow.  A lot of stress and force passes through these structures with certain activities.  The  UCL must withstand a lot of force with pitching.  The motion of pitching produces forces which try to separate the ulna  from the humerus.  The UCL prevents these bones from moving apart.

In addition to these ligaments, the muscles of the tendons that bend and flex the wrist attach to the humerus on the inner part of the elbow.  The muscle attachment to the bone can be stressed with repetitive, high energy motions and forces.

CAUSES

Injury to the elbow is common in pitchers.  The repetitive motions, stresses, and forces that go through the structures of the elbow place it at risk for injury.  The common injuries to the elbow that happens in the adult pitcher include a strain or tear of the UCL, inflammation and degeneration of the attachment site of the wrist flexors (medial epicondylitis), or an osteochondral defect (OCD) of the elbow joint surface. An OCD is where a chunk of bone and cartilage are divoted out of the joint, similar to a pothole in a road.

SYMPTOMS

Most pitchers with thrower's elbow will experience pain and swelling on the inner part of the elbow.  At times there is also loss of strength and pitching velocity.  There will be tenderness and pain over the UCL or the attachment site of the wrist flexors.  If the UCL is torn, these players will also feel instability in the elbow with throwing activities.  If there is an OCD, players may describe locking or catching of the elbow joint. 

TREATMENTS

Treatments are tailored the structure that is injured.  A pitch count is used in baseball to minimize fatigue and stress to these elbow structures.

UCL strain - These players can be treated with rest and anti-inflammatories. Changing the mechanics of throwing can minimize future injury to the UCL.  Physical therapy is used to strengthen and stretch the muscles on the inner side of the elbow.

UCL tear - These players will require what has become known as Tommy John Surgery.  This surgery is a reconstruction of the UCL.  This restores the stability of the elbow.

Medial epicondylitis - This can be treated initially with rest, anti-inflammatories, straps, and physical therapy.  At times, a steroid injection can help calm down the pain.  If an individual fails these conservative options, then surgery is needed to remove the painful tissues and reattach the tendon to the bone.

OCD - An OCD usually develops on the outer aspect of the elbow.  An elbow arthroscopy can be used to remove the loose cartilage and bone.  Since the human body is unable to regrow cartilage, the OCD lesion is cleaned and drilled to stimulate scar tissue to fill in the "pothole.".  

WHEN TO SEEK MEDICAL CARE

Pitchers who have persistent pain, swelling, or difficultly pitching should seek medical attention.

RETURN TO ACTIVITIES/OUTCOMES

Most athletes with a tear of the UCL will need surgery to have a chance at getting back to playing competitive sports.  Recovery will be prolonged and extensive requiring months of physical therapy.  Lackey will likely be throwing again 6 – 8 months after his surgery.  However, most athletes with this injury struggle to return to their pre-injury form.  He will likely miss the entire 2012 season.

VIDEO/ANIMATION

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

Oakland Raiders quarterback, Jason Campbell broke his right collarbone on Sunday against the Cleveland Browns.  What does this mean for his season?

ANATOMY

The shoulder is made up of three bones: the humerus (arm bone), the scapula (shoulder blade), and the clavicle (collar bone).   The clavicle is a long, skinny bone, which is shaped as an “s”, as it travels from the sternum (breast bone) to the shoulder. 

CAUSE

Clavicle fractures are common, occurring usually in children and athletes.  The clavicle can break with a direct blow to the bone. This can occur from a blow to the front or outer part of the clavicle.

SYMPTOMS

Individuals with a broken collarbone will have immediate pain swelling and perhaps a black and blue mark.  The shoulder and arm will be difficult to move.  There may be an abnormal bump in the location where the bone is broken.   An x-ray is usually needed to get a better idea of the location and “shift” (displacement) of the break.  A good physical exam will be needed to ensure that the blood vessels and nerves that travel near the clavicle are not damaged. 

TREATMENTS

Depending on the location of the break, the clavicle can be treated with or without surgery.  In the non surgical option, the arm is kept in a sling, in order to rest the shoulder. The patient is allowed to come out of the sling every few hours to do some basic range of motion exercises and keep the shoulder from stiffening.  The bone will take 8 to 10 weeks to heal.  Surgery is selected if: the bone is pushing up too much on the skin, the broken area of bone is very tender, or in the case of an athlete.  There are a variety of ways to treat clavicle fractures with surgery, including the application of a plate and screws or a screw or device that goes in the center of the bone and stabilizes the break. The advantage of surgery is that physical therapy and exercises can begin more quickly. 

WHEN TO SEEK MEDICAL CARE

If you suspect that you have sustained a clavicle fracture or break of your collarbone, you should seek medical attention within a few hours to days.

RETURN TO ACTIVITIES/OUTCOMES

Most throwing athletes treated without surgery will be out of throwing activities for 8 to 10 weeks.  With surgery, this can be shortened to 6 to 8 weeks.  For a quarterback the concern is whether the bone has healed enough to endure the force of throwing and tackles.  Campbell is likely out for the rest of the season.

VIDEO/ANIMATION

Dr. P

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

The third week of the NFL continues to bring drama to the field due to injuries.  Week 2 saw Michael Vick exit the game from a concussion. Today, he left the game because of a broken right hand.  Will he play next week?

ANATOMY

The hand is made up of 27 bones.  In each finger there are 3 phalanges, whereas the thumb has 2.  In the palm of the hand, corresponding to each finger is a metacarpal.  In the wrist there are an additional 8 bones.  These bones work in concert to allow motion and stability to the hand. 

Michael Vick reportedly is suffering from a “hand” fracture.  It is unclear which exact bone is injured, however the fact that a CT scan is being ordered suggests that the base of one of the metacarpals, or perhaps one of the wrist bones was fractured. 

CAUSES

A fracture of the hand is usually caused by a trauma.  This can be in the form of sporting activities where something or someone crushes the hand or drops or twists on the hand. A punch, a fall on an outstretched hand, or even a gunshot can lead to a fracture of the hand. 

SYMPTOMS

Individuals who break their hand will have pain, swelling, loss of motion, and bruising.  Depending on the location and position of the break, the finger may turn one way or the other when the fingers are flexed.  This is one of the reasons for surgery. 

WHEN TO SEEK MEDICAL CARE

If you suspect that you are suffering from a broken hand, you should seek medical attention within a week of the injury, A physical exam and x-rays are usually performed. A CT scan at times may be needed.

TREATMENT

Many hand fractures can be treated without surgery.  If one metacarpal is fractured, oftentimes a removable brace or splint can be worn for about 4 weeks.  If two or more metacarpals are fractured, but are located in the correct position, a short arm cast can be worn for 4 to 8 weeks. 

Surgery is considered if multiple metacarpals are broken, if the break is in the base of the metacarpal where it interacts with the wrist bones, if there is shortening of the metacarpal bone, or if one of the wrist bones is fractured.  Surgery can be as simple as the placement of 1 or 2 wires into the bone, holding it where it belongs, to placing plates and screws on the bone.  In any of these surgical situations, pressure is usually not allowed through the hand for 4 to 8 weeks.

OUTCOMES

Most athletes with a hand fracture have no long lasting issues.

RETURN TO ACTIVITIES

From the current reports, it is unclear of the nature of Vick’s injury.  Given that this is his non-dominant, non-throwing hand, if a metacarpal is fractured he should be able to play next week.  A special cast may be made for him to protect the hand during play.  However, if one of his wrist bones is fractured, he could be out of action for 6-8 weeks.  The CT scan that he is scheduled to get on Monday should give us a lot of insight into the nature of his injury and the time to return to play.

VIDEO/ANIMATIONS

Dr. P

---------------------------------------------------------------------------------

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics