The NBA world watched in horror as Indiana Pacer forward Paul George suffered a horrific injury Friday in a scrimmage for Team USA. The injury occurred as George collided with the basket stanchion as he attempted to contest a layup attempt by James Harden. His right leg buckled and teammates instantly reacted in shock as the medical team responded to the injury. George was placed in an air cast before being transported to a nearby hospital for surgery.
USA Basketball later revealed George suffered an open fracture of his tibia and fibula, the two lower leg bones. The classification of the fracture as open confirms that the bones did break the skin. The injury brought back painful memories of University of Louisville guard Kevin Ware, who also suffered an open tib-fib fracture in the Elite Eight of the 2013 NCAA Tournament.
An injury of this magnitude is gruesome to watch but actually can heal relatively smoothly. Following the break, George underwent surgery to have some form of hardware, likely a rod, inserted in the area. The rod will fortify the area and insure both bones properly align. Doing so allows the healing process to occur in the best possible environment and helps the bone return to its original strength.
However complications with this specific type of injury can occur and George’s recovery is dependent on several factors.
The first potential issue is infection. Open fractures are much more likely to result in osteomyelitis, an infection of the bone that stunts the healing process. However due to the quick reaction of the USA medical team and doctor’s at the hospital this risk was likely minimized.
The next area of concern is the neighboring soft tissue damage. The bone pierced skin and muscle and the extent of the damage must be determined. Any punctured muscle will require additional treatment but a greater setback would be if any neighboring nerves were damaged. Nerve tissue takes a substantially longer time to recover and would require an extended time off to combat any associated loss of function or muscle atrophy. Consider the case of Steve Nash who is still struggling with the lingering affects of a nerve issue related to his isolated fibula fracture.
Furthermore, below the knee the leg is divided into compartments that house the muscles, nerves, and blood vessels of the area. Sometimes an injury of this magnitude can cause an excess of pressure to develop within one or multiple compartments, resulting in a condition known as compartment syndrome. Compartment syndrome is very painful and can negatively impact the muscles of the leg. In some cases, it can even be life-threatening. Fortunately for George, compartment syndrome is more likely in closed fractures, though his medical team will continue to monitor for any potential developments.
The last issue that could play into George’s recovery would be any associated ligament damage. Fractures to the distal tib-fib area are often complicated because they include the supportive structure of the ankle while proximal fractures can involve the ligaments of the knee. Ligaments do not heal as fast as bone tissue and often fail to reach their initial strength. The sliver of good news here is that George’s fracture appeared to be closer to the midshaft of the bones, just above the ankle joint and below the knee, and no ligament damage is currently being reported.
Looking for comparisons for George is tough. The InStreetClothes.com NBA Injury Database did not include a single tib-fib fracture. Multiple cases of isolated tibia fractures (Kobe Bryant, Yao Ming) and fibula fractures (Kenyon Martin, Ben Wallace, Nash) have been cataloged, but the location and severity of these injuries all vary from George’s fracture. Looking to other leagues and sports reveals better examples including UFC fighter Anderson Silva and Arsenal midfielder Aaron Ramsey. However the demands of these sports are drastically different than the NBA, making any comparisons difficult.
Ware may be the best example possible and he returned to the court seven months or 220 days after the injury. However Ware was limited to nine games for Louisville as he continued to complete the rehab process. A six or seven month recovery would make a potential return following the All-Star break possible but it seems more probable the team will elect to shut him down for the entire season to insure a complete recovery. George’s rehab will be covered by the more than capable Pacers medical team who have been a top 10 staff over the last six seasons, including the second-best staff last year. More details will be provided in the coming days but this remains an unfortunate and significant setback for a player just entering his prime.