Posts Tagged ‘Dr. T.O. Souryal’

‘Jones fracture’ can be tricky, but odds are Durant heals just fine


VIDEO: OKC GM Sam Presti says it’s impossible to replace Durant

HANG TIME SOUTHWEST – The “Jones fracture” Kevin Durant sustained to his right foot is hardly unique to basketball players. However the bone in question — the fifth metatarsal — is unique, which is why pinpointing Durant’s return, plus potential complications, is met by sports medicine professionals with a certain level of caution.

“We don’t worry about this if it was, for example, the bone to the middle toe, because 100 percent of the time those heal. You never have the remote chance of nonunion when you’re considering the third or fourth metatarsals,” said renowned orthopedic surgeon Dr. T.O. Souryal, the Dallas Mavericks team physician and president of the NBA Team Physicians Association. “The fifth [metatarsal] is very unique and it’s unique because there are tendons that attach there that are constantly pulling in the opposite direction that you want the healing to take place. None of the other metatarsal bones have that stress on them. Because of the mechanics, because of the blood supply, there is that little shadow of uncertainty.

“Those of us who do sports medicine on a regular basis have a tremendous respect for Jones fracture because it looks relatively innocuous, and 95 percent of them heal uneventfully, relatively quickly. But there are a few tricky ones that don’t heal uneventfully and don’t heal very quickly.”

Thunder general manager Sam Presti said on Sunday that Durant will likely undergo surgery, and he estimated the NBA’s reigning MVP will be sidelined six to eight weeks. Souryal said surgery is the most common treatment for athletes with a “Jones fracture,” and that Presti’s timeframe is on target for this type of injury.

The fifth metatarsal bone is the long bone on the outside of the foot that connects to the little toe. A “Jones fracture” occurs toward the back end of the bone in an area that receives less blood and therefore can be more prone to difficulties in healing. For most athletes, the “Jones fracture” is caused by overuse, repetitive stress or trauma. Presti said Durant alerted the Thunder’s medical staff to discomfort in his foot following Saturday’s practice.

Because of the tricky nature of the bone, Souryal said the actual time an athlete misses can vary, sometimes healing before the six-week timetable, but also sometimes taking longer than eight weeks.

“There are some [Jones fractures] that heal in four to five weeks, absolutely, but there are some that take three, four months,” Souryal said. “And it’s difficult to tell which is which in the beginning. It’s just difficult to tell. As a result, we all have a healthy respect for this injury. In Oklahoma City, they have an excellent medical staff and I will give them tremendous credit for making the diagnosis early, and I am sure that they are in deliberations right now trying to decide what is the best course of action.”

Once the bone heals, Souryal said it will be as good as new. That’s not a guarantee that Durant can’t re-injure the foot, but odds are in his favor that he will continue on with his career with no further difficulties.

Mavs fans remember up-and-coming guard Rodrigue Beaubois, who fractured the same bone while working out with the French national team several summers ago. Beaubois underwent surgery and was on the comeback trail, but he re-fractured the bone during a workout as his return date neared and missed another significant chunk of time.

“He was one of the few percentages that did not heal fully and re-broke,” Souryal said.

The fact that basketball players are constantly running and jumping, the factors that likely led to Durant’s injury in the first place, means there is always a risk of re-injury. However, most athletes returning from the fracture, Souryal said, do not experience a setback.

“The positive spin is that the vast majority heal this fracture uneventfully and come back on time,” Souryal said. “It’s only those tricky ones, those few percentage points, that don’t. So if you play the odds, I think six to eight weeks is exactly right.”

With time, work and patience, George can return to his All-Star self

By Jeff Caplan, NBA.com


VIDEO: Mike Krzyzewski and Jerry Colangelo talk about Paul George’s injury

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.

Paul George

Paul George faces a long road to recovery from his injury.

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.”