NFL Weekend Injury Update, Monday October 23

Two starting quarterbacks, an NFL ironman and two important members of the Patriots’ suddenly-resurgent defense suffered injuries this weekend – here’s a quick look at their ailments and when they might return to their respective squads

 

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Carson Palmer being evaluated on the sideline for his left arm fracture (image courtesy of TheBigLead.com)

 

Cardinals’ QB Carson Palmer suffered an injury to his left (non-throwing) arm when he was sacked in the second quarter of Arizona’s eventual blowout loss at the hands of the Rams in London.  The Cardinals announced that Palmer had fractured “a bone” in his left arm and would need surgery.  From looking at the play and by making inferences from Palmer’s initial estimated return in 8 weeks from surgery, it’s safe to assume that he broke the ulna, one of the two long bones in his lower arm.

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Ulna (nightstick) fracture of the forearm (image courtesy of WikiRadiology)

This particular type of fracture is also known as a “nightstick” fracture, as it was once common for neer-do-wells and scofflaws to incur it while trying to protect themselves from a policeman’s nightstick – it almost always results from a direct blow to the forearm.  If the fracture is non-displaced (the fractured pieces of bone have not moved apart from each other) it can usually be treated non-operatively with a cast or brace for 6-8 weeks. If the fracture is displaced or if the patient is a high-demand athlete who possibly wants to return to play earlier than 6-8 weeks, surgery may be indicated.  Surgery involves an open incision and the placement of a plate and screws in the bone to re-align it and to ensure reliable healing.

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Example of a plate and screws fixing an ulna fracture (Image courtesy of ijoonline.com)

It was originally reported that Palmer would miss 8 weeks, but more recent reports have emerged that he would be seeking a second opinion and might return in as little as 4 weeks.  When he actually returns will largely be driven by his comfort level – it is potentially feasible that he could return in a month.  Even though the bone would not be fully healed at that point, the plate and screws could protect the healing ulna enough to allow for him to return with a still-healing fracture.  There is precedent for this in the recent NFL past – linebacker Jonathan Davis of the Panthers broke the same bone in the NFC Championship Game two years ago, had surgery almost immediately and played in the Super Bowl two weeks later.  Rob Gronkowski would serve as a cautionary tale for a fast return from this type of injury – he fractured his ulna blocking for an extra point (sigh…) in November of 2012, had surgery and returned later that season, but subsequently re-fractured the arm in the divisional round of the playoffs.  It seems safe to assume that Palmer will be back on the field this season, with the caveat that it will not be without some increased risk of re-injury.

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Jay Cutler down on the field after being sacked in the Dolphins game Sunday (image courtesy of Sun-Sentinel.com)

Jay Cutler was sacked in the Dolphins’ Sunday win over the Jets and didn’t return for the remainder of the game with what was initially announced as a chest injury – post-game x-rays and and MRI showed multiple “cracked” ribs.  This indicates that the QB broke multiple ribs, but the fractures are likely not at all displaced.  Not a whole lot to say about this injury except that it really, really, hurts.  Hurts to breathe, sneeze, cough, laugh… you get the idea.  Cutler’s return will be determined by when he can tolerate the rigors of being sacked by 300-plus pound defensive lineman, so it may be multiple weeks before the always-cheerful quarterback is back on the field.

Joe Thomas
Joe Thomas holds his injured left arm in Sunday’s game (Image courtesy of Akron Beacon Journal)

 

Earlier this season, Cleveland Browns left tackle Joe Thomas became the first player ever to play in 10,000 consecutive snaps, having played every offensive play of every game since being the third overall pick of the 2007 draft.  That remarkable streak came to an unfortunate end on Sunday when he injured his left arm on his 10,363rd straight snap.  While blocking the Titans’ Brian Orakpo he injured the arm and did not play another snap.  An MRI was performed and it was revealed that Thomas had fully torn his triceps tendon, an injury which will require surgery (the tendon is re-attached to the bone) and has ended his snaps streak and his season.  No amount of *cough* deer antler spray *cough* will allow him to return to full football activity sooner than 6-9 months, but he should make a full recovery for next season.  While it is not a terribly common injury, it is one with a good track record for reliable recovery.

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Patriots Linebacker Donta Hightower suffered a shoulder injury during the Sunday night game (Image courtesy of BostonGlobe.com)

As for the Patriots, defensive stalwarts Donta Hightower and Malcom Brown each suffered injuries in the second half of Sunday night’s game which caused them to miss the rest of the game.  It was announced that Hightower had a shoulder injury while Brown was out with an ankle injury.  While the exact nature of their injuries is not yet known (of course not, it’s the Patriots we’re talking about here), their participation in practice this week will certainly bear watching.  This is especially true in Hightower’s case, as he has a history of shoulder issues, most recently having right shoulder labrum repair after the Pats’ Super Bowl win over the Seahawks in 2015.

Bruins Update October 20 – Adam McQuaid Broken Fibula

Bruins’ blueliner Adam McQuaid suffered a broken right fibula while blocking a shot Thursday night against the Canucks – while he broke one of the same bones as the Celtics’ Gordon Hayward, his recovery should be quicker

Adam McQuaid helped off the ice after suffering a broken fibula in last night’s game against the Canucks (image courtesy of WEEI.com)

Bruins’ defenseman Adam McQuaid is as toughas they come, but he has had tough injury luck in recent seasons, and that run of unfortunate injuries continued last night. After blocking two shots during a shift against Vancouver in theBruins 6-3 win, McQuaid had to be helped off the ice and did not return. He was later diagnosed with a broken fibula and it was announced that he would undergo surgery to fix his fracture on Monday.

X-ray of a fibular shaft fracture

(Image courtesy of eORIF.com)

News of this injury likely causes a shudder to run down the spine of Boston sports fans, as it was only days ago that we learned that the Celtics Gordon Hayward would be out most if not all of the season with a left ankle fracture of his own. The key difference for McQuaid is that his fracture is from a direct blow, in this case from a speeding hunk of vulcanized rubber traveling at speeds around 90 MPH. This almost always results in a fracture of the shaft of the fibula, the area in the middle of the bone, as opposed to a rotational injury like Hayward sustained, which causes damage to the ankle joint itself. Rotational ankle fractures (so-called because they result from rotation of the ankle joint/foot as opposed to a direct blow, as in McQuaid’s injury) result in damage to the ankle joint itself and frequently the ligaments of the ankle, which results in a longer healing time. Fibular shaft fractures do not damage the ligamentous structures of the leg, allowing for a quicker recovery time. On Monday McQuaid will have a plate and screws placed in his leg, allowing for the bone to be precisely aligned and to heal reliably. He may be able to start light conditioning (stationary bike) activities within a couple weeks, and will probably start skating within 4-6 weeks. He should be back on the ice for the B’s by late December at the latest.

While McQuaid’s latest injury is obviously another in an unfortunate run of injuries for the burly defenseman, he should be back relatively soon, certainly faster than Hayward for the Celtics. Moral of the story, if you’re going to break you leg, do it by taking a puck off the shin rather than dislocating your ankle. Or, you know, just don’t break your leg at all, that’s cool, too.

To Operate or Not To Operate… That is the (Clavicle) Question

While it may not be quite Shakespearean, Aaron Rodgers’ clavicle fracture is certainly a tragedy for the Packers and their fans. With the QB heading under the knife soon, it raises the question- why do some clavicle fractures require surgery while others heal on their own?

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As Aaron Rodgers came crashing to the turf on Sunday under the weight of the Vikings’ Anthony Barr, so too, most likely, did the Packers Super Bowl aspirations, as it was later learned that the hit had fractured Rodgers’ right clavicle (“collarbone”). It was announced today that Rodgers’ injury would require surgical fixation, almost definitely ending his season. Rodgers’ injury brings up memories of other NFL quarterbacks with clavicle fractures in recent seasons – Rodgers himself in 2013 and the Cowboys’ Tony Romo in 2015. Both of those injuries resulted in the quarterbacks losing parts of their seasons – both missed 8 weeks but were able to return the same season without surgery. Rodgers was injured in week 9 but was  returned for the regular season finale and the postseason, while Romo was hurt in week 2 and came back in week 11, only to re-fracture his clavicle in week 12 and miss the remainder of the season. In both cases, the injured QBs were able to return in the same season without surgery – what was different about these fractures that allowed them to avoid the operating room?

One obvious difference is that Rodgers’ previous fracture and Romo’s fracture were in their left, non-throwing shoulder. That, however, is not the key determinant in whether or not a clavicle fracture benefits from surgery. The primary factor in whether or not to operate on such an injury is “displacement”, or the degree to which the bone fragments have separated.  Rodgers’ 2013 injury and Romo’s fracture were both “non-displaced”, meaning that the bone was broken but the pieces had not moved – essentially a crack in the bone.

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Non-displaced clavicle fracture in blue circle

Fractures such as these, or minimally displaced fractures which have moved only a few millimeters, can almost always be treated without surgery.  These still require 6 to 8 weeks to fully heal, as evidenced by Rodgers’ and Romo’s recoveries, with the arm being allowed to rest in a sling for comfort and healing purposes. Essentially all of these will heal without surgery and allow for a full recovery. Given the Packers quick announcement of the need for surgery for Rodgers’ current fracture, it’s safe to infer that this injury falls into another category of clavicle fractures, displaced fractures. In these types of fractures, the fracture fragments have moved apart to such a degree that they are less likely to heal without surgical intervention to re-align the bone.

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Displaced Clavicle Fracture

While surgery is not mandated in these types of clavicle fractures, it is often recommended for a number of reasons.  Most noticable for patients, stabilizing this type of fracture makes them much more comfortable in the short term, as the mobile fracture fragments are quite painful.  More importantly in the long term, however, is the fact that surgically realigning the fracture improves the function of the shoulder and arm by restoring the proper shape and length of the bone and decreases the chance that the bone might not heal on its own.  While non-displaced fractures have a rate of healing that approaches 100%, widely displaced fractures can have a 5-15% rate of non-union (failure to heal) when treated without surgery.  While an 85% chance of healing might be enough for the cheesehead in the discount double-check commercial, it’s certainly not high enough for the All-Pro quarterback in the same ad.  Primarily for this reason, Rodgers will undergo surgical fixation sometime in the near future, resulting in an x-ray that will likely resemble the following plate-and-screws construct:

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Clavicle Fracture After Fixation with Plate and Screws

Post-operatively Rodgers will likely be in a sling for 4-8 weeks, gradually resuming range of motion and light strengthening before resuming more aggressive workouts. Full contact would likely not be allowed for about four months, and given that this is Rodgers’ throwing shoulder, it will likely take him at least that long if not longer before he is comfortable making the throws he will need to make.  The end result of all this is that Rodgers’ season is almost definitely finished, but he should make a good recovery from this injury – the rate of healing after this type of surgery is very high and should allow him to regain full strength and throwing accuracy.  Long story short – don’t plan on getting any fantasy points out of Rodgers this season, but if you’re in a keeper league, hold onto him – he should be good to go for 2018.