Dev Mishra, M.D.
Founder and President, Sideline Sports Doc
Medical Director, Apeiron Life
Fellow, American Academy of Orthopaedic Surgeons
Institute For Joint Restoration, Menlo Park, CA
March 2, 2021
- Tibia fractures are complicated injuries, typically requiring many months of recovery before a return to sports.
- An “open” fracture, in which the broken bone is exposed to the outside environment through a break in the skin is a serious and unique situation requiring emergency, complex treatment.
- Timing of return to sports after treatment for an open tibia fracture are unknown, but typically much longer than return after a fracture without a break in the skin.
Paul George and Alex Smith are two famous American athletes who made it back to their professional sports after a serious tibia fracture.
doctors take away from the field injured player
This week everyone interested in golf is asking the question: will Tiger play again?
There is much that we don’t know about Tiger’s injury, but there are some general conclusions we can make based on the published scientific literature.
The key with each of these athletes is that they have a type of injury called an “open” fracture, one in which the broken bone is exposed to the outside environment through an opening in the skin. The bone healing is critically important, of course, but for open fractures it’s the skin healing and possibility of infection that often determine the success of overall healing.
What Is An “Open” Fracture?
An open fracture is a broken bone that penetrates the skin. This is an important distinction compared to fractures that don’t go through the skin. When a broken bone penetrates the skin there is a need for emergency treatment to clean the skin, preserve muscle and other soft tissues, and to stabilize the bone. For Tiger, Paul George, and Alex Smith the initial operations were done within a few hours from the injury.
Infections With Open Fractures
All open fractures are considered contaminated because of the communication between the fracture site and the environment outside of the body. The likelihood that bacteria have entered the fracture site is dependent on a number of variables including the severity of the injury, the damage to soft-tissues, and the environment where the injury occurred. As of this writing, I’ve not seen any publicly disclosed details about the extent of the skin opening in Tiger’s injury.
The most likely bacteria to contaminate a wound are the normal bacteria that are found on the skin surface of your body. Open fractures in specific environments may lead to exposure to specific bacteria. For example, a football player injured outdoors on grass has a different exposure compared to a basketball player playing indoors.
Timing Of Return To Sports
Most of the published research on tibia fractures involves treatment of fractures without an initial break in the skin (a “closed” fracture). One review paper found these general statistics:
- 91.5% of patients with tibial shaft fractures treated surgically returned to sports, although fewer (an average of 75% in different studies) returned to the same level of play.
• 66.7% treated nonsurgically returned to sports.
• Timelines for return to sports were highly variable. Tibia fractures treated surgically had a range of 12 weeks to 54 weeks for return to sport; fractures treated without surgery ranged from 28 weeks to 182 weeks
Timing Of Return To Sports After Open Tibia Fracture: Unknown
There is simply not enough published data available to predict return to sports after treatment for an open tibia fracture. From personal experience I can tell you that successful return is typically much longer than for a closed fracture. Individual cases from the world of pro sports support the longer scenarios. Paul George took about 8 months to return to the NBA. Alex Smith’s complicated recovery has been very well documented and took about 2 years.
In Tiger’s case, the reports available so far indicate that his tibia injury involved multiple other bones (the fibula and the talus are mentioned), and the tibia fracture was not a break in a single place. Additionally, he had a soft tissue procedure to relieve pressure on the muscles, called a “fasciotomy”. Every situation is unique, so for Tiger at this stage it’s impossible to make any comparisons to the published scientific data.