Devastating.  Gruesome.  Catastrophic.  Grotesque.  Just a few of the words used to describe the injury sustained by University of Louisville guard Kevin Ware on the night of March 31st.  Most of us have seen the footage by now – Ware coming down from a jump onto his right leg and then collapsing onto the floor, followed by reactions ranging from terror to tears among the players and the fans.  So what happened, and what is next?

As the footage shows, Ware landed primarily on his right leg, generating up to 2500 lbs. of force.  It’s hard to say without seeing the footage up close, but it would seem that his leg was planted just slightly forward.  The tremendous downward and forward force on his leg was transmitted through his tibia and fibula and resulted in the bones cracking in the middle of the shaft, to the extent that the tibia protruded through the skin.  This is what is known as an open fracture, and surgery must be performed as quickly as possible to restore proper blood flow to the foot, if indicated, and restore the alignment and soft tissue coverage of the bone to avoid a bone infection, which can be very difficult to treat.  As reported, surgeons placed a rod through the shaft of the tibia to hold the bone in place while it heals.  And as with any musculoskeletal, orthopedic, or podiatric leg, foot or ankle injury, the body wants to heal, we just have to let it do so.

So will he be OK?  Most likely yes.  This injury did not involve a joint, so post traumatic arthritis, which can develop around 10 years after a fracture involving a joint, will likely not be an issue.  And since the injury occurred in the middle of the shaft of the leg, stiffness of the knee or ankle should not be a problem either.  Kevin’s homework now is to rest, probably for the next 6 weeks, and then if the bone is healed, start physical therapy to restore the muscles and tendons that will have atrophied.  Remember that muscle atrophies at a rate of 3% per day of inactivity.

And how does this affect my NYC podiatry patients?  Probably not directly.  I must admit, not a ton of open tibial fractures limp into the NYC office, and in general open tibial fractures occur at a rate of 2 per 1000 injuries, so maybe not that many anywhere.  And what is gruesome to the public, is sort of interesting to any practicing podiatric or orthopedic surgeon, and especially to the residents in training.  Kudos to those who skillfully cared for Kevin Ware, and a speedy recovery to Kevin.  Go Blue! (Sorry, Kevin)

See you in the office.

Dr. Ernest L. Isaacson