2016-05-16 10:54:24 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.
Louisville player Kevin Ware’s nasty compound fracture has been the talk of sports medicine since the team's victory over Duke last week sent them to the NCAA Final Four.
But, unfortunately, he’s not out of the woods yet. The biggest complication he could face is an infection.
Today, I had the chance to speak with WAKR’s host Ray Horner about this topic.
I discuss the definition of a compound fracture, what could have caused Ware’s bone to snap like that, and what potential complications he could face.
Below is a transcript of our discussion and the audio file.
Horner: Let’s bring in my good friend, Dr. Joe Congeni over at Sports Medicine Center at Akron Children’s Hospital. Joe, when you look at the youngster from Louisville with that real bad fracture, and you’ve got the Gronk (Patriots tight end) now we’re hearing in sports medicine in the NFL might get another surgery because of infection, these are kind of touchy situations, aren’t they?
Dr. Joe Congeni
Dr. Congeni: Yeah, we didn’t get a chance to speak last week about Kevin Ware, but that injury, obviously, was the talk of sports medicine circles last week. But, the two could be tied together because, you know, you’re not totally out of the woods yet. You have to make sure that we avoid that biggest complication, which is infection.
about three points that I want to just bring up about the Kevin Ware situation.
First of all, everybody is talking about that fracture and throwing around the term, compound fracture. That was the definition of a compound fracture: The break goes through the skin. You could see the bone through the skin. That was the part that made everybody pretty sick to their stomachs.
Now, the talk was that it was 6 inches through the skin and you could see the bone sticking out, and that part of it is what makes it a compound fracture.
But, the fact is, once they operate on that, they do really, pretty well. So, they do an operation, they put hardware in — in his case a rod, I think a fairly strong metal rod — that will actually help it heal. And in most of the cases, these kids do really well.
Often within 4 to 6 months, they are back playing sports again. So, that’s the good news on a compound fracture.
The second part is right away when you saw Kevin Ware’s fracture, medical people were saying, “Uh oh, could this be a pathologic fracture?” Because you know, Ray, athletes do this so often.
He really was jumping just to close out on a 3-point shooter and lands with a lot of force on the shinbone. But for it to snap that badly, when we talk about pathologic fracture, we’re thinking could there be something that weakened that bone that put it at risk to snap like that?
In athletes, most of the time, we’re suspicious there could have been an underlying stress fracture, which are sometimes really hard to tell on plain X-rays and things. a microfracture, where he maybe had an injury already and that caused it to snap. We do see that a couple times a year in athletes who ignore these stress fractures and then go on to a compound fracture later.
A pathologic fracture could be due to weakness of the bone, like osteoporosis — we wouldn’t expect that in a college athlete — or a stress fracture, or a cyst in the bone, or something in the bone that caused it to be weak and snap like that. So, the other issue was pathologic fracture.
And then the third thing you and I talked about is the biggest complication is infection. He’s still not totally out of the woods, but these have pretty high, I mean, pretty fair infection rates.
And we saw in Gronk, the tight end from New England, he had several surgeries on his forearm this year. They were trying to get him ready for the play-offs. Normally in a high-school kid, you would have let that heal on its own.
But, they operated on him a few times and sure enough, after one of the operations, he got an infection. He’s gonna have problems being ready for the season; he may need another surgery.
So, the biggest risk when you have to get in there and fix it, and sometimes more than once, is getting a bad infection.
Horner: Alright, Joe, good information as always, my friend. Welcome back and we’ll catch up with you next week.
Dr. Congeni: Alright. Thanks, Ray. Have a good week.
Horner: You too.
(8 a.m.-4:30 p.m.)
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