Randon Hall, MD
Analysis of Top 5 Sports Injuries of March 2018
(Modified) Original Photo by Bo Mertz
Justin Turner's Wrist Fracture
Justin Turner was struck by a pitch in his left wrist during a spring training game against the Oakland A's. X-ray confirmed a non-displaced wrist fracture. The injury is to his non-dominant, non throwing left hand. Based on reports his fracture is minor and will not need surgery. Furthermore, his return to play will likely be fairly short due to the fact that he can be put in a protective brace to participate in fielding activities. Return to batting may be delayed based on pain. Possibilities of minor fractures that he could have include a non displaced fracture of the distal radius (below), buckle fracture of the ulna (below)or ulna styloid fracture (above). No specific diagnosis has been made other than wrist fracture however expected return is in 4-6 weeks, likely end of April early May.
Kevin Durant's INJURED RIB
Kevin Durant was placed on injured reserve due to a rib injury. Reports state he is likely to miss 2 two weeks just prior to the NBA playoffs. Specifically, he was diagnosed with an incomplete cartilage fracture of the rib. His injury is unique in that it is not actually of the bony part of the rib, it is of the cartilage connection of the rib to the sternum. Incomplete means that it has not broken all the way through the cartilage attachment. These type of injuries likely occur from either direct impact to the area or from wear and tear through the season. I suspect this is an overuse injury and has been slowly developing over time. The diagnosis was made with an MRI of the chest which is typically used when looking for a stress injury or injury to the cartilage. Many times rib fractures are unlikely to show up on an x-ray. The reports state that he will be out for two weeks however that is a true unknown in this situation. When the rib injury affects the bony aspect of the rib we have a good idea to how long the bone will take to heal. When it affects the cartilage healing rates can vary dramatically and it can become a recurring issue that returns when activity is resumed. I expect this to be a nagging injury.
Case courtesy of Dr David Cuete, Radiopaedia.org. From the case rID: 27347
Isaac Haas' Fractured Elbow
In the first round of the NCAA March Madness Tournament star center for Purdue Isaac Haas sustained an elbow fracture. The injury occurred with a direct fall on to the tip of the elbow. Although he tried to return he was quickly pulled back off the court. The injury was furthered evaluated after the game and x-ray confirmed a fractured elbow that requires surgery. Based on how the elbow impacted the ground, my guess is he sustained an olecranon fracture of the elbow. Other options include a displaced radial head or radial neck fracture to name a few. There is now talk of him returning to play with a brace but this seems pretty risky. It is possible that the the medical team feels that surgery is now not needed but it also possible that he can delay the surgery until a later date.
Bumgarner Sustains Fractured Hand In SprinG Training
Madison Bumgarner sustained a hand fracture in a spring training game this Friday. It is reported that injury occurred due to a line drive that his pitching hand. The details are lacking in the reports, but it appears that he has a fracture to the little finger that requires surgery. He potentially could have a fracture to the finger itself, however it is possible that he has a fracture to the metacarpal bone which would be exposed out of the glove. A fracture can occur anywhere along the bone, but the most frequent locations are the head, neck, shaft or base (pictured above). Typically a plain x-ray can determine the extent of the fracture. Due to this being his pitching hand it is likely that he will be out for approximately 6 weeks.
What is Happening with Kyrie's Knee?
Kyrie Irving sustained a knee cap fracture in 2015, which ended his season and required surgery. The fracture likely required surgery due to the spacing between the fracture fragments (above). If the fracture fragments were greater than 2 mm apart then the surgeon needs to pull the pieces together in order to align the fragments. This is usually done using a surgical wire or surgical screws. What wasn't reported is that the entire under surface of the knee cap is covered with cartilage. If the knee cap breaks so does the cartilage underneath the bone. The difficult issue with this type of surgery is that one has to be able to align the cartilage back perfectly to be able to get the smooth and painless motion you had prior to the surgery. That is if the fracture did not occur in a way that caused the cartilage to be damaged permanently, such as a chipped fragment that was too small to be repaired. Once the cartilage is injured arthritis will inevitably follow at some point. He is set for "minimally invasive surgery", which, to me, means they are doing a diagnostic scope of the knee and going to see if there is anything that can be cleaned up. Keep in mind no mention of hardware removal, means that is likely not the primary issue.
Steph Curry's MCL Sprain
Steph Curry sustained a possible MCL sprain last night after a collision with his own teammate on the court. Usually the injury occurs with a force from the outside of the knee towards the inside of the knee. If you remember Steph had a previous MCL injury back in 2016 for which he was out 2 weeks. He will have an MRI today but if there are no surprise I would expect 2-4 weeks for return. In general, isolated MCL injuries can be treated without surgery and will improve with time and proper rehabilitation. Usually the athlete is placed in a functional hinged knee brace, which will allow flexion and extension of the knee but limit side to side movement. A mild MCL strain (Grade 1) may only need 1 or 2 weeks recovery, up to about 4 weeks. Grade 2, partial tear, typically will recover in 4 to 6 weeks. A Grade 3, complete tear, can take upwards of 8 to 10 weeks. Rarely, if the knee is very unstable, Grade 3 tears could require surgical intervention. With a deplete Golden State Warriors squad they will depend on Curry heavily, however his ability to cut, drive and defend will be affected in the first round of the playoffs.