Read this
USATSI
Mandatory reading for the class.
Stephania Bell is an injury expert for ESPN and she wrote a detailed, informative piece on Kevin Durant’s injury and recovery. Yeah, it was in the links already today, but I think it’s important, so here’s more.
It clears up a number of sweeping generalizations and misconceptions, some of which being that Durant “rushed back” in December, that his foot injury is a sign of pending career doom a la Bill Walton and Yao Ming, and why the Thunder did a bone graft now, and not then.
Because some prefer to remain ignorant to these types of things so as to feel empowered to shout out their hot takes about the organization or medical personnel, instead of, you know, relying on the factual information and medical research, it would be really nice if everyone read the article. But in an effort to aid the lazy, here are the most important parts blockquoted:
1. Durant’s chance at recovery is very high.
The concern for many fans now is whether Durant will be able to return to the player he was just a year ago and if it can happen in time for next season.
The answer to both questions is, simply, yes.
Despite the failure of his foot to cooperate with the initial plan following his original injury, medical evidence suggests that Durant’s chances for a successful return next season are very high.
2. Healing feet is hard.
The challenge in trying to heal from a fracture in this area is that the bone does not have a particularly good blood supply, which results in a frequent failure to heal independently, even with immobilization. For this reason, surgical fixation of Jones fractures (with implantation of a screw) has become the standard of care, especially in elite athletes, who will return to high-stress activities and whose specific movements in their sport put them at an otherwise increased risk of failure.
Unfortunately, even when the fracture appears healed and an athlete recovers functionally to the point of being able to return to competition, problems can recur.
3. Durant’s bad ankle sprain in December against the Warriors may have played a factor.
Other lower-extremity biomechanical factors such as poor lateral ankle stability can influence the amount of stress to which the outer foot is subjected (think of the most common sprain in basketball, rolling the outer ankle so the sole of the foot turns inward). A lateral ankle sprain not only stresses the lateral ligaments of the ankle, it forces undue loading onto the outer aspect of the forefoot at the vulnerable region of the fifth metatarsal.
4. Durant did not “rush back.” He merely came back when he was supposed to.
Durant’s original injury was projected to keep him out for six to eight weeks; he returned in seven. While some may speculate he returned to action too soon, there is no doubt that those overseeing his care were monitoring the healing of the fracture along with Durant’s report of symptoms and his response to progressive activity.
Other NBA players have returned in similar timeframes without incident (For example, Tobias Harris, who suffered the injury in high school, has not had a recurrence. Brandon Jennings, now sidelined with a torn Achilles, did have a Jones fracture in 2010 and recovered fully after surgery.)
5. What is a bone graft and why does it work?
So why is this latest procedure expected to be successful in healing Durant’s problematic fracture? One of the benefits of bone grafting is that it directly places cells with a healthy blood supply in an underserved area, which may, ultimately, enhance the healing potential of the bone. In an article published in the American Journal of Sports Medicine in 2011 looking at bone-grafting procedures performed on re-fractures or non-unions of the fifth metatarsal in 21 elite college and professional athletes, the success rate for return to prior level of competition was 100 percent. At over two years’ follow-up, only one athlete had suffered a subsequent re-fracture (the re-fracture was sustained in a motor vehicle accident, not in sports).
6. Next paragraph: “For those who might be wondering why not go with the bone grafting procedure first…”
…it’s a more invasive, more complex surgery that requires a significantly longer healing time and it simply isn’t necessary in the majority of cases. Of the many athletes who sustain a Jones fracture that is surgically repaired, only a range of 5-10 percent will go on to have persistent problems that require bone grafting.
7. Players heal just fine after this.
According to Dr. Norman Waldrop, an orthopedic surgeon specializing in foot and ankle injuries at Andrews Sports Medicine who has treated numerous Jones fractures in elite athletes, the good news is that for those who do require grafting, there is rarely any further treatment required. “Over 90 percent will go on to be fully competitive and free of complications for the remainder of their playing careers,” Waldrop said.
Brooklyn Nets center Brook Lopez is perhaps the most recent example of a player to undergo surgery to address a re-fracture of the fifth metatarsal. Lopez had surgery last January and has played without incident so far this season.
8. If you’re bringing up Bill Walton and Yao Ming, you’re doing it wrong.
It is also important to point out the Jones fracture is not the same type of dreaded “big man” injury that plagued Yao Ming or Bill Walton. Their fractures were to the navicular bone, a bone in the midfoot that forms a keystone of the arch on the inner aspect of the foot. It too has a poor healing supply and fails to respond in some cases even despite surgical intervention. It is vastly different from a Jones fracture and a navicular fracture that is resistant to healing can be a career-threatening injury. It’s worth noting there are no reported cases of an NBA player’s career ending as a result of a fifth metatarsal injury.
One side thought from me: The people that keep bringing this up to paint the picture of team incompetence or whatever, are basing it off a player that got hurt in the 1970s, and a guy that was 7-foot-6 and 400 pounds. They also probably don’t think you should vaccinate either.
9. And finally…
Still, the medical evidence tells us there is every reason for Durant, the Thunder and his legions of fans to have confidence in his foot heading into the fall.
