If this doesn't break your heart, you're a monster.

If this doesn’t break your heart, you’re a monster.

 

There are few players as universally well-liked or as incredibly talented as Steven Stamkos, and few injuries as overtly horrifying as the broken leg he sustained Monday against the Bruins. Viewers had a front-row seat to a leg bending a way legs aren’t made to bend, and to Stamkos’ considerable pain.

Stamkos broke his right tibia, and there’s video here if you’re of the rubbernecker variety. Be warned that it’s difficult to watch, not just because of the injury, but because of his reaction to it. He tries to get up and skate on it twice, then finally gives up and lies on the ice alternately covering his face and clutching at Tom Mulligan, Tampa’s head athletic trainer. It was every bad injury from the past several seasons all over again, and like Pitkanen’s heel, Fedun’s femur, Pronger or Laperriere’s puck to the face, it was one of those injuries that you instantly knew was going to be very, very bad.

Screen Shot 2013-11-12 at 12.32.27 PM

See if you can spot the tibias in this diagram!

 

The tibia is the most commonly fractured long bone, but can also have some of the worst complications. Stamkos needed surgery because his fracture wasn’t a simple break that could be casted and ready to go in six weeks. Surgery is required for unstable fractures (meaning the bone is angulated or shortened), open fractures (where the bone has penetrated the skin), comminuted fractures (the bone is in several pieces), or fractures that extend into joints – and keep in mind the tibia is part of the knee at the top and ankle at the bottom.

 

Speaking of surgery…

Note the bonus fibula fracture on the left. On the right is a repaired tibia (and the fibula will heal on its own).

Note the bonus fibula fracture on the left. On the right is a repaired tibia (and the fibula will heal on its own). This is not Stammer’s leg, this is an internet leg.

 

While surgery isn’t necessarily required for closed nondisplaced fractures, and any time you cut someone open you increase their chance of infection, surgery leads to better outcomes than just casting alone. In Stamkos’ case his fracture was apparently displaced, hardly a surprise given that for a brief moment he had an extra knee at about mid-shin. The bright spot is that the surgery was scheduled for the day after the injury, so there probably wasn’t any major vascular or nerve injury – those would have constituted a surgical emergency.

IM (intramedullary) nailing is the mainstay of surgical treatment for tibial fractures. It involves cutting small incisions at the top and bottom of the lower leg, and shoving a metal rod down the center of the bone, essentially splinting it from the inside. The advantage is that unlike a cast, this allows for early mobilization of the rest of the leg. When you cast a leg for six weeks in nonoperative management, you end up with a very stiff knee and ankle (and a weird skinny leg). As an added bonus, the smell of a six-week-old cast lies somewhere between dog fart and dead groundhog on a nastiness spectrum.

 

Rehab timeline

Stamkos’ rehab will depend on exactly what kind of injury he had – whether there was joint involvement, whether they nailed or plated his leg, and how bad the soft tissue swelling is. Assuming the absolute best case scenario…

Day 1 post-op: Lie in bed with your leg elevated and in a bulky splint/dressing and feel sorry for yourself. Eat lots of Cheetos. Wish you could scratch under the dressing.

One week post-op: Go back to the doc for a wound check. Maybe start touchdown weight bearing (meaning you can touch your toes to the floor but can’t put weight on them), knee and ankle mobilization. Start suffering at the hands of evil physiotherapists. Continue eating Cheetos.

Six weeks post-op: Back to the doc for x-rays to make sure everything is still in place. Hope that everything is still in place. If everything is still in place, increase intensity of physiotherapy. Curse at physiotherapists. Grudgingly give up Cheetos.

Three to four months post-op: X-rays. Bone healing should happen in about sixteen weeks. If things aren’t in place at that point, a second surgical procedure could be required at this point to get everything back in order. More physiotherapy. Start hockey-specific training with the goal of getting back in game condition.

Four to six months post-op: May be able to fully bear weight and walk without crutches. HEY GUESS WHAT MORE PHYSIO.

Six to twelve months post-op: Return to full activities without restriction. Maybe.

The above broad and inexact timeline is what you could expect from a normal (non-NHL) person. The advantage of being an elite athlete is that you have access to elite resources, and NHL players tend to recover faster than the average person. None of this takes into account any possible complications, like a need for re-operation (if the bone doesn’t heal, heals weird, or the hardware moves or causes pain), postoperative pain, stiffness, or loss of conditioning.

 

So what are you saying, exactly?

While the Lightning’s main concern is for Stamkos’ long-term health and ability to continue his career, this has of course brought up the question of whether he’ll be able to play in the Olympics. The Olympics are three months away, so while technically it’s possible he could play, it’s unlikely. He could potentially still be partially non-weight bearing at that point. He could also be completely fine. The complexity of the fracture and the course of his rehab will impact his readiness, and those remain unknown variables. The early buzz is that this is likely a season-ender. But Stamkos is only twenty-three, and really frigging good at hockey, so assuming this injury heals well and he continues to be impossibly good, he’ll have more opportunities to play Olympic hockey – just maybe not in 2014.

 

Steve Stamkos and Jon Cooper are adorable

Cooper on Monday’s game and the Stamkos, Salo, and Aulie injuries:

“We went 16 games without anybody being hurt and the snowball went down the hill today. It was a little tiny guy and it ended up a mountain when it got to the bottom of the hill.”

 

Adorable.

 

Stamkos on Twitter the evening of his injury:

 

 

ADORABLE.

Comments (10)

  1. “… like Pitkanen’s heel, Fedun’s femur, Pronger or Laperriere’s puck to the face, it was one of those injuries that you instantly knew was going to be very, very bad.”

    You might add Matt Cooke’s severing of Erik Karlsson’s achilles tendon.

  2. Hey what about Staal’s puck to the fa…oh nevermind.

    I dont remember much from my childhood, but I clearly remember how freaked out I was when I saw a gymnast fall off the uneven bars and send part of her tibia right through her skin. Scared the poop out of me.

  3. A quiet room I have a passing familiarity with! I went the wrong way into the end boards and broke the fibula down by the ankle. Good times.

    Jo, you got one thing very wrong here. You don’t start swearing at the PT folks in week 6. You start swearing at them the first time they touch your leg that still looks like an overcooked sausage. You just ramp up the creativity in the swearing from there. The cheetos are mandatory, as they help the percocet work more effectively.

  4. This injury was gross to watch, however it was like watching sesame street compared to this one http://www.youtube.com/watch?v=CUAMGrWiV6w

    • Ooooof.

      I saw Napoleon McCallum have his leg bent inexorably wrong-way-on at the knee during a Monday Night Football game – I think the Ware injury is right there with it. I think with Stamkos, it was jarring because one assumes that the shinpad should act as a protection, or at least a splint of sorts. It was like he was only wearing the sock when he hit that post. One shudders to think if this had happened back in the days when the posts didn’t break away but were anchored by deep spikes into the ice.

  5. “It involves cutting small incisions at the top and bottom of the lower leg, and shoving a metal rod down the center of the bone, essentially splinting it from the inside.”

    Question: If you put a metal rod inside a bone… does that mean it’s there for the rest of your life? How would you remove it without re-breaking the bone…?

    This makes me equal parts confused and glad that the only time I broke a bone was before I was 2 (27 now), and so I have a great story but no memories of the pain :)

    • It would be there forever.

    • No, they take them out all the time. If it never bothers the patient, then it stays in there forever. But some people have problems with them (pain, it gets bent, etc), so they extract them. Basically they make those incisions again, back out and remove the screws holding the rod in place, then pull the rod out the way it went in.

  6. Sorry for my bad english, but i’m writing from Finland. :) I accidentedly found this post via google, while was looking for the information about Steven Stamkos injury. I had my tibia broken in march this year, by falling down when skiing. I think that you Jo, are the first person who had described incredible well “how it feels like when you broke your tibia”. I’m glad for that. So many people around me had been asking me about healing and they have been wondering why i’m not walking after three months from accident. They all should read this post. :) Still i’m not a NHL-player. Well… I thank you for the great post. And by the way, i’m going to have my intramedullary nail away in spring 2015 because the upper screws causes some pain in the back of my knee. Need to say that this has been the most painful time of my life. Luckily i’m already working, but still got some pain. Thanks Jo and have a nice winter for you and thumbs up that Mr. Stamkos will get well soon and we will see him playing in olympic-hockeyteam!

  7. In some situations incidents like this should be taken seriously. Good to know we have this Chiropractor and Physiotherapists around.

Leave a Reply

Your email address will not be published. Required fields are marked *