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Dr. Christian Balldin on Kevin Ware’s Horrific Leg Injury

The injury that Louisville’s Kevin Ware sustained is a gruesome one to watch.  An open tibia fracture is something that is much more common in higher energy type mechanisms such as motor vehicle collisions.  The fact that he sustained this injury simply from landing on his leg with some twisting makes me think that he almost certainly had a stress fracture in that area.  When he landed on that leg, his tibia was simply unable to withstand the forces due to the already weakened area and he completed the fracture.  Due to the twisting and force of the landing the bone, unfortunately, came through the skin thus coming in contact with the outside world.  This makes the situation worse not just because of its gruesome appearance but because of the now much higher chance for infection and potential for additional problems.

Open tibial fractures (when bone breaks through the skin) are known for taking a long time to heal as they simply do not have the same blood supply and muscular envelope that other long bones have (i.e. the femur, radius and ulna).  They may take longer than a year to fully heal and occasionally they do not heal.  This is especially the case when infection sets in.  One of the more important points regarding open fractures is the need for antibiotics within a few hours of the injury in order to decrease the chance of infection.  An open tibia fracture requires urgent surgery to irrigate and debride the bone as well as stabilize the fracture.
A tibia fracture that occurs in the middle of the bone is treated with an intramedullary nail (IMN).  This nail is usually a titanium rod with a few screws at the top of the bone near the knee and a few screws near the ankle.  It is a very stable construct and allows for immediate range of motion and often weight bearing very shortly after surgery.  The fibula (the other bone in the lower leg) often breaks along with the tibia but the vast majority of the time it is treated without any internal fixation and heals on its own.

Kevin Ware will be in the hospital for a couple of days for IV antibiotics and therapy but will hopefully have a speedy recovery and be back on the court before next season.

Dr. B. Christian Balldin is an orthopaedic surgeon, fellowship trained in sports medicine.  He treats patients aged 3 years and up and his special interests include sports injuries and fracture care.  To schedule an appointment with Dr. Balldin, please call 210.281.9595.

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