Broken leg? There's no broken legs in the playoffs!

 

Hal Gill has had quite a year. A trade from Montreal to Nashville, a new two-year contract with the Predators, and surgery on his leg. Oh, and that playoff series against the Coyotes? He did that on a broken leg. The leg that ended up needing surgery. Yes, you can actually play hockey on a broken leg if you load it up with enough anesthetic. It also helps if you’re a badass, which Hal Gill apparently is.

Hal Gill’s leg vs. Sheldon Souray

On April 5th the Predators played their second-last game of the regular season against the Dallas Stars. If you weren’t paying attention, that’s the team that signed every single available free agent this summer, and then a few extra guys for good measure. In that game Hal Gill blocked a Sheldon Souray shot, which isn’t anything special for a guy who finished in the top 20 shot blockers in the league. The unusual thing about that particular shot was that it found a way through his pads and broke his leg. The unusual thing about that broken leg is that he didn’t realize it was broken for a while. Usually that’s the sort of thing that’s pretty obvious.

How the hell do you not know your leg is broken?

Your don’t know your leg is broken if you have a set of normal x-rays. Here’s the thing about broken bones. They’re sneaky little buggers. That’s why when you have x-rays for a suspected fracture they’ll generally do at least two views of the area in question – what looks normal from one angle may look pretty obviously messed up from another. And sometimes despite the radiologist’s best efforts, particularly sneaky fractures may not show up on x-ray until a week or two later. The sneakiest of the sneaks are the fractures that are closed (no bone poking through the skin) and non-displaced (as in all the bone is still lined up where it belongs).

Gill’s first set of x-rays were normal, and so he assumed he just had a bad bruise. He missed the Detroit series, but was back for the Phoenix series on a fractured tibia that was caught on a second set of films.

Meet your tibia.

The tibia is the larger of the two bones in your lower leg, and it’s the one that bears the weight. That’s why the other bone (the fibula) can be harvested to replace bone in other places, like Ray Emery’s bum hip.

Now you're a tibia expert.

Being the larger of the two bones and the bearer of the weight makes you a pretty big deal. Being half of the knee joint and a large portion of the ankle makes you an even bigger deal. So how does a guy play five hockey games on a brroken big deal bone like the tibia? BADASSERY. And also drugs.

You too can play on a broken leg!

Gill played in the Phoenix series with his right ankle anesthetized, meaning he had something injected into that joint to keep the screaming pain at bay. Bupivacaine is a likely culprit, as it’s similar to the lidocaine your dentist uses to freeze your mouth for fillings, but lasts much longer (about three hours). Why freeze the joint? Remember what I said about the tibia making up a large portion of the ankle? Take another look at the picture above. By “large” I mean most. and by “most” I mean “hey remember what I said about the fibula not doing much?”. Gill was likely the proud owner of a distal tibia fracture (down near the ankle). There are a few options for anesthetizing that area, including injecting anesthetic into the area directly around the bottom of the tibia itself, or injecting directly into the joint. I’ve had my wrist joint injected, and I’m confident in saying that I easily could have punched a shark in the face, won an arm wrestling contest, climbed a telephone pole one-handed, and played a full 18 holes of golf with a wrist that felt like it was full of ground glass mere minutes before (Note: I did none of these things). That first option of injecting around the tibia itself is similar to a technique I absolutely love called a hematoma block. When a fracture is displaced and needs to be set (realigned), it can really, really hurt the patient to have you yanking on it. A hematoma block involves injecting the area of bleeding around the fracture (yes, bones bleed) with anesthetic. It sounds awful, and it is, but it works. You stuff the needle in until you hit bone, and you inject a whole bunch of anesthetic in there. That initial bone-hit is a bitch, but once the lidocaine (bupivicaine, etc) gets in there, the patient is handing you vials in the hope you’ll keep going (not really, but it does make the fracture feel better).

So how do you actually fix a broken ankle?

If you’re lucky and nothing is displaced and you’re not an NHL player, you may just end up in a cast or a cam walker boot. Like every other orthopedic accessory I’ve ever looked up, the cam boot is available on Amazon (of course). Depending on your fracture and your orthopedist, you could be on crutches not allowed to bear weight, you may be weight-bearing as tolerated, or you may be stomping happily around in your boot waiting for the okay to finally take that smelly thing off. You can get cam boots with an adjustable angle at the ankle, with internal air bladders for padding, of varying heights, and with varying numbers of straps. The common thread is that each and every last one of them will be disgusting after six weeks of wearing it everywhere except in your bed and your shower. Enjoy!

If you’re not lucky or you’re Hal Gill, you have surgery on your ankle (after finishing up a playoff series against the Coyotes). This is our old friend the ORIF (open reduction – internal fixation), although if your fracture isn’t displaced there’s not really any OR and just a whole lot of IF. If you’re really, really not lucky you could break the tibial shaft, and end up with an intramedullary nail (aka an IM nail – a big rod through the bone) and spend the next four to six months healing it.

Ankle surgery: The bits and pieces are kind of pretty.

While you might think you need a gigantic incision on your leg to make room for plates, the good news is that minimally invasive bone plating is possible, and it works. A small incision is made, and the surgeon shoves a “bullet tipped” plate up in there. The plate’s tip is somewhat pointy (hence bullet-tipped), which allows it to slide under the muscle up against the bone. Then through a combination of voodoo and luck*, they know where the other end is, cut a little hole, and screw it down. Then they screw down the rest of the plate, close the hole, and send you and your boot to physical therapy**.

* They actually use special sizing guides that show the plate length on the outside of the leg, and intraoperative x-ray. Voodoo just sounds a lot cooler.

** This is obviously a massive oversimplification. Going into vivid detail would bore us all to death, and that’s why we should all be glad there are people who enjoy that sort of thing and really, really want to be orthopedic surgeons.

The plates come in a variety of shapes and colours depending on who makes them, and what part of the bone the’re meant for.

Wright Medical makes adorable anterior tibial plates in a cheerful shade of green!

Once your plates are in place and you’re out of surgery you may get lucky and have a surgeon who gives you your post-op x-rays. These are great at parties, so always ask for a set if you have orthopedic surgery.

GUYS THIS IS IN MY LEG. IN THERE. RIGHT NOW.

Rehabbing a broken leg sucks.

Welcome to the world of physical therapy, stinky cam boots, and not playing hockey for a while. A month or two is going to be what you’ll need to heal that fracture (unless you got an IM nail, in which case seeya next season). Gill is reportedly set to start skating soon, so if you’re counting (which you’re not because I did it for you because that’s how much I care about you) he’s about three months out from surgery. As far as the hardware is concerned, it should stay in there forever. Sometimes they’ll take it out, but that’s generally only in cases of infection, if the bone didn’t heal right, or if any part of the hardware has managed to work its way partway out (which is super gross).

The upshot of all this is that Hal Gill is tougher than you, he had a really good excuse for being slow in the Phoenix series, he should be good to go for the beginning of the season, and you should follow him at @skillsy75 on the tweets, because you never know when he’ll post a gem like this:

You bet he captioned this "I'm the highest paid one!"