Randon Hall, MD
UEFA Champions League - Why Does Neymar's Foot Fracture Require Surgery?
Why DID they Rest him for three Days?
Paris Saint Germain's forward, Neymar, sustained both a foot and ankle injury in a game against Marsielle on Sunday, February 25th. Initially thought to be a sprained ankle, further x-rays revealed a fracture of the the superstar attacker's fifth metatarsal bone. Neymar's injury would have been diagnosed with a simple x-ray. He most likely had a CT scan as well, which gives the greatest detail of a fractured bone but is not always necessary. Preliminary reports stated that he was under strict medical protocol for three days until a joint decision was made to proceed with surgical repair of his broken foot. The "medical protocol" most likely was simply keeping him from putting any weight on the foot while waiting for the final decision. Honestly, the three day rest treatment was more of a formality, as it was very unlikely that anything would have changed in his clinical status in that short time period of time.
Why does Neymar's injury require surgery?
In addition to the sprained ankle, Neymar most certainly has a Jones fracture. A Jones fracture is a fracture of the fifth metatarsal bone at a very specific location called Zone 2 at the base of the fifth metatarsal. The area of the injury is known for having poor blood supply compared to the other areas of the bone and does not heal as well. Due to the blood supply issue, the Jones fracture has a higher chance of developing non-union at the fracture site, which will dramatically prolong recovery and return to play. In non-competitive athletes, if there is not significant separation of the fracture site, it is reasonable to attempt to treat these fractures without surgery. The individual will likely need to be non-weight bearing for 4 to 6 weeks in a cast and then progressed to protected weight bearing for another 4 weeks. Full return to play would be expected in 8 to 12 weeks. Admittedly, the non-surgical treatment of this fracture is a controversial topic as treatment protocols vary. The dilemma for a competitive athlete is that you could go through a non-surgical protocol and still not have complete healing. Therefore, it is a distinct possibility that if Neymar did not have surgery now, he could have needed it in 8 to 12 weeks when the fracture did not heal. This is likely the discussion that the medical staff was having during the three days after the injury.
What is Neymar's Return to Play?
Surgical treatment of the Jones fracture involves a surgical screw placed into the fifth metatarsal, in order to tightly hold the fracture together and ensure proper healing. The other benefit of the screw fixation would be to allow greater strength of the bone at the time of return to play. In general, competitive athletes with surgical screw fixation of a Jones fracture, look to return at around 8 weeks. I think that a 6 week return would be theoretically possible but quite ambitious and risky in this situation.
ANATOMY OF FIFTH METATARSAL BONE
ZONE CLASSIFICATIONS OF FIFTH METATARSAL BONE
A Jones Fracture is located in Zone 2 of the fifth metatarsal. This are of the bone has relatively diminished blood supply compared to the other areas of the fifth metatarsal bone. Fractures in this area are considered high risk and may need surgical repair especially in competitive athletes.