The NBA season tipped off Tuesday evening and not even six minutes in, the viewership witnessed one of the more gruesome and gut-wrenching injuries we’ve seen in some time.
Boston Celtics starting forward and major free-agent acquisition of the summer Gordon Hayward appeared to get his left foot caught underneath him — it was abducted and everted; in English: toes pointing out and ankle “rolling” out — and landed with his entire body weight on his foot after going up for an alley-oop dunk attempt.
It was later reported that Hayward suffered an ankle fracture — more specifically a tibial fracture and ankle dislocation per Celtics head coach Brad Stevens — and will be flown back to Boston rather than stay in Cleveland to undergo further testing and assessment.
It’s an extremely unfortunate injury for one of the league’s premier players and people.
Ankle fractures are relatively common worldwide but aren’t during basketball games. There are four main kinds of ankle fractures: unimalleolar, bimalleolar, trimalleolar and pilon.
The malleolus is the “bump” on either side of the lower leg and is traditionally thought of as the “ankle.” The malleolus on the outside (the lateral malleolus) of the ankle is the end of the fibula, the small non-weight-bearing bone in the lower leg, and the malleolus on the inside (the medial malleolus) of the ankle is the end of the tibia, or shin bone.
There is a third structure known as the posterior malleolus that can’t be visualized from the outside and is the back (posterior) extension of the tibia. The number of malleoli that are fractured determines if the ankle fracture is uni-, bi- or trimalleolar. A pilon fracture involves a break of the tibia and often the fibula just above the malleoli. Uni- and bimalleolar fractures are more common than trimalleolar fractures, which account for a mere 7 percent of all ankle fractures.
As of this writing, it is unknown what type of ankle fracture Hayward suffered. It’s likely we may never know.
Although surgical intervention is not always needed for ankle fractures, the likelihood for surgery increases with increased number of malleoli involved as well as if an associated dislocation occurs. Essentially, the more malleoli involved, the more likely a dislocation.
Surgical fixation usually involves reducing — putting the fractured bone pieces “back in place” — the injury and placing screws and plates to stabilize the bone. It takes roughly six weeks for the bone to grow together — the technical term is “union” — however, the strength of the bone doesn’t typically return to normal for up to a year or two. The likelihood of soft tissue (ligaments and tendons) involvement increases the more severe the fracture is.
Despite the bone being fairly quick to heal, healing and the resulting stiffness of the ligaments and tendons surrounding the ankle joint as well as atrophy of the musculature of the involved lower extremity prolong the recovery time. Typically, patients aren’t cleared for total weight-bearing on their involved leg until 1.5-2 months after the procedure, depending on the specific fracture, which leads to the above-mentioned side effects.
The physical rehabilitation process involves progressing from light range of motion and strengthening exercises to help improve the patient’s ankle flexibility and strength to more functional activities once the bone is completely healed. The early phase of rehabilitation begins almost immediately after surgery and progresses over the next six months or longer. It has been estimated that the patient returns to 80 percent of their prior function over the first six months of their rehabilitation, but do not reach 100 percent even after two years.
As of writing, it is difficult to know with 100 percent certainty if Hayward will miss the entire 2017-18 season. What is certain is that he did not suffer your every day, run-of-the-mill sports injury and will miss a significant amount of time. It’s an unfortunate injury that can only be chalked up to bad luck. Hayward should be able to return from this injury and play again in the future, but it would be inappropriate to speculate at this point in time how long that will be and to what extent he will be affected moving forward. Hayward will return in time, but to expect anything other than that at this time would be inappropriate.
Sources:
- http://orthoinfo.aaos.org/topic.cfm?topic=a00391
- http://orthoinfo.aaos.org/topic.cfm?topic=A00527
- Hong CC et al. Impact of trimalleolar ankle fractures: How do patients fare post-operatively? Foot and Ankle Surgery. 2014; 20: 48-51.
- Beckencamp PR et al. Prognosis of Physical Function Following Ankle Fracture: A Systematic Review With Meta-analysis. JOSPT. 2014; 44(11): 841-851
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