I’ve never liked the old saying, “Sticks and stones may break my bones…” As a kid that was picked on growing up, I found it largely inaccurate. Words can and do hurt. But now, years later, the saying drives me crazy for an entirely different reason. The injury analyst in me is constantly asking, “Well what kind of break are we talking about here? More details please!” I ask only because all bone fractures are not created equal and vary in mechanism of injury, amount of damage, and necessary treatment and intervention.
A bone fracture can be open, in which the bone pierces the surrounding tissue, or closed and isolated to the bone. The break can be a greenstick fracture that occurs frequently in adolescents and involves an incomplete break similar to the snapping of a green tree branch. Bone can splinter into multiple pieces in a break known as a comminuted fracture or it can be an avulsion fracture that happens when a muscle or ligament pulls away a tiny piece of the involved bone. Numerous other classifications exist including linear, transverse, and spiral fractures, each with their own set of complications.
The last few months the sports world has been filled with various types of fractures. Indiana Pacers guard Paul George suffered an open fracture of both his tibia and fibula. Sixers rookie Joel Embiid may miss the entire 2014-15 season managing a stress fracture in his foot. Brazil’s run in the FIBA World Cup may have ended differently had Neymar not suffered a fractured vertebrae in his back. In Major League Baseball, Giancarlo Stanton suffered a season-ending orbital fracture after be struck by a pitch while Pirates outfielder Andrew McCutchen missed time with an avulsion fracture to one his ribs. Bone fractures are more likely in a violent sport like football, a trend that has held true through three weeks in the NFL.
New Orleans Saints running back Mark Ingram will miss at least three more weeks recovering from surgery to realign a displaced fracture in his hand. Rookie Teddy Bridgewater has taken over the starting quarterback position in Minnesota after Matt Cassell suffered multiple fractures to his foot. However it is San Diego Charger running back Danny Woodhead that has endured the most significant bone fracture thus far, suffering a spiral fracture of his ankle in the team’s win over the Bills.
Bleacher Report’s Will Carroll is reporting Woodhead’s fracture is a very specific type of spiral break known as a Maisonneuve fracture.
Bad news for Danny Woodhead. His fracture is a complicated one called a Maissoneuve. A spiral fracture on top of high ankle rupture.
— Will Carroll (@injuryexpert) September 21, 2014
The Maisonneuve fracture, named for French surgeon Jules Germain François Maisonneuve, occurs when the foot is planted while the leg is violently twisted outward. The torque on the leg tears the ligaments of the distal ankle, disrupts the connective tissue between the two lower legs bones, and causes the fibula to break near the knee. Associated avulsion fractures the lower ends of the fibula and tibia can also occur. Often the injury is reported as a high ankle sprain with a fractured fibula. The resulting damage can leave the ankle almost completely unstable and surgery maybe necessary to restore joint integrity.
Woodhead is expected to visit with other surgeons to determine the best course of treatment, though surgery appears likely. His season is all but over and he will spend the next several months recovering and rehabbing. A 2011 review of Maisonneuve fractures and treatment showed a high success rate in recovery, though the length of time evaluated ranged from six months to six years. Given that Woodhead is an elite level athlete and will have access to high-end medical equipment utilized by skilled professionals, a six-month recovery seems realistic with additional treatment carrying over into training camp.