What Exactly Happened?
September 9th, Tennessee Titans TE Delaine Walker sustained a horrific injury. While being tackled his ankle twisted awkwardly resulting in his ankle being turned 90 degrees from its normal position. The injury occurred week 1 and is reminiscent of Gordon Hayward's injury for the Boston Celtics that was covered extensively in the media as it was the first game of the 2017-2018 NBA season. The confirmed diagnosis at this point is an ankle dislocation and fracture. The ankle was relocated on the and further tests will be performed to determine the full extent of his injuries. Walker will likely undergo surgery to repair the broken bone and stabilize the ankle. This blog post is going to take a step by step approach to understanding the injury, surgery and recovery. Let's start with the ankle dislocation.
Ankle Dislocation
There are three bones that make up the ankle joint. Those bones are called the fibula which sits laterally, the tibia which sits superior and medially (inside) and the talus that sits inferiorly. There are also several ligaments that help to hold the ankle joint in place. When an ankle dislocation occurs, the talus comes out from under the tibia to sit outside of the true ankle joint. It is possible for this to occur without a fracture, but this is usually not the case. When the ankle dislocates the ligaments by default are torn. If a patient has a simple ankle dislocation, with no fracture the patient can be treated with cast immobilization to allow the ankle to heal. One treatment option is to place the patient in a cast and progress them to a boot and gentle physical therapy at about 4 weeks, with likely return to play at approximately 3 months. The pictures below depict the normal position of the ankle.
Ankle Fracture & Dislocation
When the talus is forcibly pushed out of the ankle joint it can cause the surrounding bones of the fibula and tibia to become broken. In the case of Delanie Walker, it is not clear if he sustained a fracture of the tibia, fibula or both. Remember, this would be in addition to the supporting ligaments that are by default torn during the dislocation process. An MRI would be helpful to determine the extent of ligament damage as well as if any cartilage damage has occurred. When the tibia or fibula is broken, the surgical repair usually involves a screw fixation to stabilize the fractures. Gordon Hayward likely underwent a similar fixation to the tibia bone as well as ligament stabilization procedure. The picture below shows both a fracture of the tibia and fibula that can occur with an ankle dislocation. You will also see how the screw fixation is performed to stabilize the fracture.
Pre-Surgery
(Modified) Original Photo by Laurel F., Creative Commons
Post-Surgery
(Modified) Original Photo by Laurel F., Creative Commons
Treatment Timeline
Based on Gordon Hayward's timeline here how things should go for Walker. On October 18th Gordon Hayward underwent surgery to stabilize his ankle and fix his fractured tibia. It appears he was placed on a non weight-bearing status, which is why he was using a scooter initially. Approximately one month later, he was transitioned to a walking boot and placed on crutches. About 3-4 weeks later in early December (2 months post-op) he was transitioned from the walking boot to an ankle brace and cleared for full walking. 3 months postoperatively he was seen shooting set shots so likely cleared to light activity. At 5 months the intensity of his training has progressed to the point of dribbling and shooting, therefore he is most likely cleared to agility drills and non-contact activity. Keep in mind he should be doing cross training, conditioning and upper body lifting throughout the recovery process.
Return to Play
My estimate is that Delanie Walker's timeframe would not be until about 6 months which would put him out for the season. At this point, it is all but certain he will not return this year and that doesn't look to be changing, but he will be back.