Breaking Down Derrick Rose’s Facial Fracture and Iman Shumpert’s Wrist Injury

NBA teams are just days into training camp and the injuries for the 2015-16 season have already begun. Two Eastern Conference contenders were hit hard with ailments that will require surgery for key backcourt players. In Chicago, Bulls guard Derrick Rose is slated for surgery after suffering a facial fracture during practice while Cleveland swingman Iman Shumpert is out after undergoing wrist surgery.

Rose’s injury is fairly common in the NBA as multiple players have suffered fractures to the face and skull. Last season alone guards Victor Oladipo, Russell Westbrook, Rajon Rondo, and Mike Conley all missed time recovering from various facial fractures. has previously looked into the trends of these injuries but let’s so a quick review.

The skull is made up of two primary parts, the area that surrounds the brain and the facial skeleton. The facial skeleton is comprised of 14 fused bones that serve as anchors for the various muscles of the face. Of these 14 bones, the two nasal bones are the most frequently broken while the eye socket, or orbit, is also susceptible to injury.

The orbit is made up from bones of the face and the neurocranium and surrounds and protects the eyeball. Injuries to the area are particularly complicated as the eye can be damaged and vision problems can arise. The severity of the fractures depends on the bones involved, whether or not they shift, size of the actual fracture, and any soft tissue and/or muscle damage. Surgery is often performed if the damage is severe and a bone has displaced. Any considerable damage to the eyeball would also warrant surgical intervention.

Multiple factors help shape an individual’s return to play. To start any concussion-related symptoms have to dissipate. Second, if surgery is required then the length of time missed is often extended. Finally the bone or bones involved also shape a potential recovery window. Nasal fractures and cheekbones often heal quickly as was the case last year when Westbrook missed just one game due to a zygomatic arch fracture. However this fracture is away from the eye socket and any associated vision issues are avoided. Orbital fractures that require a trip to the operating table have forced NBA players to miss an average of 13.6 game or roughly three to four weeks.

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The Bulls have yet to release a firm timetable for Rose’s expected to recovery though history suggests he has a realistic chance of being ready for the regular season opener on October 27 when Chicago hosts Cleveland. Last season, Oladipo suffered an orbital fracture during the preseason and was back in action 20 days after his surgery.

ECUWhile Rose’s availability remains in the air, Shumpert will not be in uniform as he is expected to miss three months recovering from wrist surgery. The former first-round pick sustained a rupture of the sheath that surrounds the tendon of the extensor carpi ulnaris (ECU). The ECU sits on the pinkie side of the lower arm and is responsible for extending the wrist and performing a motion known as adduction (similar to a karate chop). Fluid motion is dependent on arm position and to aid in stability the tendon of the muscle is anchored down by a sheath of connective tissue. The sheath is vulnerable to injury, particularly following repetitive motion like those performed by golfers and tennis players. However the sheath can be injured following an isolated high-stress episode, like slamming your wrist on the rim during a dunk. While ruptures are rare, surgery remains the best option and has a high success rate.

Comparable injuries in the NBA are hard to come by. Rashard Lewis suffered a tendon sheath tear in his right hand that caused him to miss 52 days and 22 games. Shumpert’s current teammate James Jones suffered a more extensive injury in a similar area when he tore the tendon of the extensor muscle during the 2008-09 season. Jones returned to action 86 days (2 months and 25 days) later after missing 36 games for the Heat. While the sample size is small, these examples suggest the current timeline released by the Cavaliers is reasonable and perhaps a bit conservative. However it seems likely that Shumpert sits for the first 20 to 25 games of the regular season.

Last year’s NBA season was dominated by injury and unfortunately this year isn’t off to the best of starts. Fortunately neither one of the injuries can be considered season-ending and both players should be able to help their respective team contend for the Eastern Conference crown.

Understanding Tony Romo’s Collarbone Fracture

One week after losing wide receiver Dez Bryant to a broken foot, the Dallas Cowboys’ injury woes continued in Week 2 with quarterback Tony Romo suffering a fractured left clavicle (collarbone).

The injury occurred to his non-throwing shoulder when he was taken down by defensive end Fletcher Cox. The weight of linebacker Jordan Hicks compounded the fall, sending a high amount of force through Romo’s body and creating the perfect mechanism of injury for a collarbone injury.

The clavicle is one of the most frequently fractured bones in the body due to its poor protection. It plays a crucial role in two of the four articulations that make up the shoulder complex. The sternoclavicular (SC) joint is the only connection between the arm and the trunk of the body and is located where the clavicle joins the manubrium of the sternum (breastbone). The collarbone continues along the shoulder until it meets the acromion of the scapula (shoulder blade), forming the acromioclavicular (AC) joint. Here the collarbone serves as a strut for the shoulder, creating a pivot point that allows for a high degree of motion.

If Romo’s injury is an isolated fracture then the nature of the break comes into play. If the bone did not shift and remains non-displaced, the four-time Pro-Bowler could avoid surgery and would simply need to let the bone heal. If a significant displacement has occurred, surgical hardware would likely be inserted to stabilize the bone and insure proper healing. Location of the break is also key. Injuries to either the SC or AC joint can complicate a collarbone fracture and delay Romo’s return. However if the injury is to the middle third of the bone, it will set up Romo for a smoother recovery, regardless of surgical intervention.

Predicting a return to action is a bit difficult without knowing what treatment options the Cowboys will utilize but let’s look at what history and other data suggests about the injury.

To start, this marks the second time Romo has broken this collarbone. During Week 7 of the 2010 season, Romo broke his left collarbone in a similar fashion. He was struck by Giants linebacker Michael Boley and his left shoulder was forced into the turf in the process. Romo would miss the team’s final 10 games. However the team’s poor overall record likely influenced Dallas’ decision to place him on the IR. Green Bay Packers quarterback Aaron Rodgers missed seven games during the 2013 season after breaking his non-throwing shoulder just like Romo. He did not need surgery for the fracture. Last season former Philadelphia Eagles and current St. Louis Rams quarterback Nick Foles missed the team’s final eight games with a collarbone fracture of his own. The Cowboys can even look to an in-house comparison as Hall-of-Fame quarterback Troy Aikman missed five games of the 1998 season with a fractured left collarbone.

While the demands of the quarterback position are different, expanding the analysis to include players outside quarterbacks does, interestingly enough, offer some hope for Cowboys fan. Saints receiver Marques Colston missed just two weeks after breaking his collarbone and having it surgically repaired. Running back Ryan Mathews was back in action in just under seven weeks following his right clavicle injury and surgery in 2012.

Furthermore, a 2010 study of NFL players examined 19 mid-third collarbone fractures that were treated both nonoperatively and surgically. The average time of healing for non-surgical breaks was 7.3 weeks while those treated surgically needed an extra 1.5 weeks to heal.

Monday will be key for the Cowboys as they ultimately decide on what treatment option to utilize with their franchise quarterback. Considering the team proactively decided to utilize a bone graft in Bryant’s fractured foot, don’t be surprised if Romo goes under the knife as well. Surgery would improve stability and insure the pieces of bone properly fuse together. Either way it appears as if the 2-0 Cowboys will have to navigate the next few weeks without their starting quarterback and Pro Bowl receiver.

Understanding Dez Bryant’s Fifth Metatarsal Fracture

The Dallas Cowboys’ Week 1 win over the Giants was exciting but costly as wide receiver Dez Bryant suffered a broken foot during the game. The injury occurred to the fifth metatarsal of his right foot and will require surgery on Tuesday.

Frequent readers of know the injury well as it was thoroughly discussed last season after Oklahoma City Thunder forward Kevin Durant suffered the injury during the preseason. However let’s revisit the specifics.

The metatarsals are the long bones that comprise the foot and bridge the tarsal bones of the midfoot to the individual bones of the toe. As its name suggests, the fifth metatarsal is located on the outside of the foot, at the base of the pinkie or fifth toe. The fifth metatarsal serves as an anchor for several muscles, including the muscles responsible for moving the foot and outward as well as up and down. Unfortunately this makes the bone vulnerable to breaking when the ankle is forced inward, most commonly after making a hard cut or landing on the foot of another player.

Fifth metatarsal injuries can occur in multiple locations in a variety of ways. As previously mentioned, avulsion fractures of the bone can occur when a muscle pulls away a piece of bone. Stress fractures in the fifth metatarsal are also common and these generally develop along the mid-shaft of the bone. The most serious of these breaks is the Jones fracture, an acute break that occurs near the base of the bone. Jones fractures are particularly problematic because the amount of available blood to the area is limited, stunting the healing process. As a result, Jones fractures generally require surgical intervention in hopes of avoiding a delayed union or nonunion.


To complicate things surgery does not guarantee a speedy recovery and the odds of a re-fracture in the area are high, as Durant experienced first-hand last year in his lost season. Problems following surgery generally are associated with the surgical hardware as it can bend, fail, or even break. Follow-up procedures are often utilized to address any hardware-related problems, lengthening the time missed.

According to the database, one out of every three NBA players that required surgery to address a fifth metatarsal fracture suffered a second fracture or needed a follow-up surgery, including Durant, Glen “Big Baby” Davis, and Brook Lopez. NFL players, especially wide receivers are no stranger to the injury either, as Atlanta’s Julio Jones and former Giants receiver Hakeem Nicks have endured the injury in recent seasons. Unfortunately the precedent set by these and other receivers doesn’t bode well for the Cowboys.

Jones initially broke his left fifth metatarsal during the 2011 scouting combine. The Falcons drafted him anyway but he wasn’t cleared to run until 10 weeks after surgery. The foot was a non-factor until the 2013 season when he re-broke the area and needed a second surgery that forced him to miss the final 11 games of the year. Nicks broke his foot during OTA’s in late May of 2012 and spent the next 13 weeks recovering before returning for the final preseason game of the year. The foot remained an issue throughout the season, limiting his snaps in practice and games. More recently rookie receiver DaVante Parker missed nearly three months of activity after the Dolphins proactively addressed a hardware issue with a fifth metatarsal injury he suffered in college.

Dallas has another example to consider having previously dealt with this type of injury. Last season defensive end DeMarcus Lawrence suffered a fractured fifth metatarsal during a summer practice and missed the first eight games of the season after being placed on the PUP list. The team initially believed he would miss eight to ten weeks.

Looking at these examples, the four to six recovery window offered by Dallas appears to be a best-case scenario. Bryant, a fiery competitor, may be his own worst enemy, as rushing back from this injury could prove to be detrimental to his long-term health, especially given his injury history. To start, this is Bryant’s second surgery on his right foot and ankle. During his rookie campaign, Bryant fractured his right fibula and a surgical plate was inserted to stabilize the area. Insuring no extra stress is placed on that area will be key to avoiding any potential cascade injury. Furthermore, the nature of the injury will limit Bryant’s ability to condition and he will need additional time to get back up to speed when he is cleared to resume football-related activity. This will be particularly important when you consider his recent hamstring problems. Any setback there would simply delay a potential return.

Given that the ink on his 5-year $70 million extension with the team is barely dry, I’m betting the Cowboys will ultimately play things a bit more conservatively. History also suggests Bryant will miss more than the currently predicted amount of time, though the Pro-Bowl wide out appears hell-bent on returning to the field as soon as possible. In the meantime the Dallas offense will have to make due without a key piece of their aerial attack as a team with title aspirations looks to make a run at Super Bowl 50.

Examining Dante Exum’s ACL Injury and Other Injuries in International Play

In 1992 the Dream Team took the world by storm as NBA players collectively returned to the Olympic stage. Their impact still resonates today, as players from 15 different countries were drafted during the 2015 NDA draft, including two international players, Kristaps Porzingis and Mario Hezonja, taken in the first five selections as well as second round selection Satnam Singh Bhamara, the first draft selection from India. Just last week NBA players participated in the NBA Africa Game, an exhibition game in South Africa that marked the first ever NBA game on the continent of Africa.

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NBA and Its Players Take Steps To Improve Overall Health

July 8th was a big day in the NBA but not for the reason everyone will remember. Lost in the endless stream of emojis, hostage negotiations, and all the other shenanigans associated with the DeAndre Jordan saga, were several announcements that have the potential to improve the overall health of the NBA player and reduce the high number of NBA games lost to injury.

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