By Jeff Caplan, NBA.com
HANG TIME SOUTHWEST — The injury suffered by Paul George Friday night during the USA Basketball Showcase in Las Vegas was shocking, but the Indiana Pacers’ All-Star small forward can make a full recovery and even regain the tremendous explosiveness and athleticism he displayed on the very play on which his lower leg snapped.
To get to that point is going to take time, perseverance and a lot of sweat.
He suffered what’s called an open tibia-fibula fracture of his right leg, meaning he fractured both the tibia and fibula. George was immediately taken to the hospital and underwent surgery performed by USA Basketball team physician Riley Williams (who is also the team physician for the Brooklyn Nets). The procedure typically involves inserting a titanium rod over the fracture and using screws to hold it in place.
The good for news George, an All-Star in each of the last two seasons, is that while the injury is rarely seen in basketball, it is a common sight among orthopedic surgeons. The procedure to repair it is also very common, according to Dr. T.O. Souryal, head physician for the Dallas Mavericks and a renowned orthopedic surgeon in sports medicine who is also president of the NBA Team Physicians Association.
“This is orthopedic surgery 101. They know what to do with an open tibia fracture,” Souryal said. “We see this injury in car accidents, we see this injury in motorcycle accidents, we see these injuries with people falling off a ladder, we see these injuries on the soccer field, so this is a relatively common orthopedic trauma injury. There’s a long track record of dealing with this injury and dealing with the issues that are unique to this injury.
“What makes this unique is that it was videotaped from five different angles.”
George, 24, faces an exhaustive rehabilitation process that begins immediately with simple, muscle-firing exercises that can be done from his hospital bed. As George moves away from early recovery challenges — such as infection — in the initial weeks following surgery, his rehab will escalate incrementally in intensity, complexity and duration as the bone heals over a period that typically spans 4-6 months. Souryal cautions that healing time for the tibia can be slow and involve complications, but he noted that for a young, well-conditioned athlete such as George, odds are high for a clean healing process.
Once the bone heals, the real work for George begins with what Souryal terms the late challenges. Regaining motion in his ankle and knee are crucial as George then begins the gradual strengthening process. A regimen that includes — at various phases — a stationary bike, walking on the underwater treadmill or zero-gravity treadmill and ultimately weight machines and leg presses is typical.
“During the recovery and healing, both of those joints can be involved in the injury, so he has to work on getting his mobility back, getting his knee moving normally and getting his ankle moving normally, and ultimately getting his strength back,” Souryal said. “During the stages, sometimes you’re on crutches, sometimes you’re in a machine or in a cast and you suffer a tremendous amount of atrophy. Part of the recovery is going to involve strengthening, and that by itself takes a long time to get your strength back.”
Will Carroll, sports injuries writer for Bleacher Report, recently spoke with Dr. Bert Mandelbaum about George’s injury. Mandelbaum is one of the top orthopedic physicians in sports medicine and said George can expect to be on crutches for six weeks.
“Then the athlete gradually progresses to rehabilitation, physical therapy and cross training,” Mandelbaum told Carroll. “Once the fracture healing is strong, the athlete will return for progressions to practice and games. Once completed, most athletes can perform at pre-injury levels.”
Souryal, who has not examined George, but has treated numerous similar injuries, agrees. Souryal said George’s final hurdle will be getting his explosiveness back, a goal that will challenge George both physically and mentally. But it is one that can be reached.
“That’s always the last thing to come back after a major injury like this,” Souryal said, “is your ability to explode and dunk the ball and have the confidence to land back on that leg.”
Once George completes the recovery process, one which Souryal cautions against setting a timetable because of the numerous variables in play at this early stage, Souryal said George can feel confident that he won’t re-injure his leg. Souryal said the bone heals stronger than it was prior to the injury and the titanium rod inserted during surgery reinforces it.
Unlike an ACL injury, Achilles injury or other soft-tissue injury in which consideration of re-injury is always present, Souryal said the risk of re-injury with a tibia fracture “is almost zero.”
George’s recovery process will be grueling and require patience. But through it he can remain focused on the likelihood of resuming his burgeoning career where it left off. How long that takes will depend on how quickly the bone heals followed by the rigorous, time-consuming strengthening process.
“Can he be back to his old self? Yes,” Souryal said. “How long will that take? I don’t know.”