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

America’s Team’s quarterback, Tony Romo, was taken out of Sunday’s game for a broken rib.  Remarkably, he was able to return to play in the second half.  Today we learned that he had punctured a lung, a condition known as a pneumothorax.  What is this and how long will he be out?

ANATOMY

The rib cage is made up of the ribs, collar bone (clavicle), and breast plate (sternum) of the chest.  These bones and the tendons, muscles, and ligaments that connect them serve to protect the internal organs of the chest.  These organs include the lungs, heart, esophagus (a tube running from the mouth to the stomach), and trachea (the tube running from the mouth to the lungs).  There are 12 ribs on either side of the sternum.

CAUSES

Rib breaks or fractures are usually due to a blunt trauma, as with Romo, or a sharp trauma, such as with a gunshot wound.    A break of the ribs can potentially cause damage to the underlying organs.  If the force is great enough, the broken bone can be plunged into the lungs.  The air that was in the lungs now escapes and enters the space between the ribs and the lungs.  This is known as a pneumothorax.    The pneumothorax can be small.  In this case, the puncture usually seals itself and the body removes the air over time.  In a large pneumothorax, the air pressure can build up to the point that the trachea starts to close down.  This is life threatening and can lead to death.

SYMPTOMS

Individuals with a rib break will experience pain, difficulty with deep breathing, coughing, sneezing or even swallowing.  There will be pain when pushing on the rib.  If a pneumothorax develops, the individual may suffer from shortness of breath, difficulty with breathing, difficulty with swallowing, and see a shift of the trachea in the neck.

WHEN TO SEEK MEDICAL CARE

If you suspect that a rib fracture or pneumothorax, you should seek immediate medical attention.  A physical exam and x-rays are usually performed.

TREATMENT

Most rib fractures are treated without surgery.  These breaks usually do not penetrate the underlying organs but are painful.  Pain medications, anti-inflammatories, a brace, ice, rest, and activity modifications are usually enough to treat these injuries.

If a small pneumothorax is present, chest xrays are obtained every day to make sure that the air is going away.  If it enlarges, a chest tube may be needed.  A chest tube is a device that is placed through the skin and between the ribs.  The tube is placed into the space between the lungs and the ribs.  It serves to rest the lungs and get rid of the air between the ribs and the lungs. Very rarely is surgery needed.

If a large pneumothorax is present, a chest tube is needed.  Very rarely is surgery needed.

OUTCOMES

Most athletes with a simple rib fracture can return to all activities within a few days, as long as the pain is being managed well.  For those with a small pneumothorax, they are able to return to sports within 1-2 weeks. For those with a large pneumothorax, they are able to return to sports within 4-6 weeks.

RETURN TO ACTIVITIES

From the current reports, as long as Romo’s pneumothorax stays small, and if his pain is well controlled, he will be able to play this weekend.  However, he will likely be wearing extra protection around his ribs.

VIDEO/ANIMATIONS

None

Dr. P

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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