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The Latest On Kevin Ware’s Injury

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Louisville players hold up Ware's jersey as they celebrate their win on Sunday. (credit: Andy Lyons/Getty Images)

Louisville players hold up Ware’s jersey as they celebrate their win on Sunday. (credit: Andy Lyons/Getty Images)

Written by Dr. Dave Hnida, CBS4 Medical EditorIf you didn’t see it, you probably have heard about it.

A healthy 20-year-old athlete jumping to block a shot, then landing in some awkward way that caused his lower leg to snap.

And snap may be an understatement. When Kevin Ware’s foot hit the floor, his shin bone shattered in half, and reportedly poked out six inches through the skin.

On a routine play, on a peaceful Sunday afternoon, the last thing you expected to see was a basketball player lying on his back with his mid shin bent at 90 degrees with raw bone sticking out. Not the knee but the shin.

RELATED: Louisville Perseveres Over Duke After Ware’s Gruesome Leg Injury

First… how could it happen? No idea. And I don’t think anyone ever will figure this one out. My best guess is that he had a small weakness in his shin (tibia) due to an early, small stress fracture. He may not have even known he had it.

Even then, there had to be an odd, yet perfect, combination of an a high vertical jump, while moving in a forward position, and landing on a heel with a locked ankle and knee. Some one in a million torque is the only explanation for an injury like this. I mean, how times does a basketball player jump in a game? Or in a season? Or in a career?

Kevin Ware

Kevin Ware on Monday at Methodist Hospital in Indianapolis. (credit: University of Louisville)

The main times I’ve seen injuries this bad were:

1) automobile accidents
2) war

Both situations that involve high velocity trauma. Never with a simple jump.

Second: what’s next? Remember, I’m speculating on the usual course of this type of injury. Each one is different, and I haven’t seen X-rays nor did I watch his surgery. But I have done surgery on injuries like this in Iraq.

And surgery is a key. It took place tonight, and took 2 hours to perform. That’s good news.

One MAJOR worry with this bad a fracture is bone splinters cutting or crushing the main artery in the lower leg. Lose blood supply and you lose circulation to the ankle and foot. That thankfully did not apparently happen.

The other reason for a quick surgery is infection. An open wound with a broken bone is an invitation to severe, limb and life threatening infection. The wound must be cleaned thoroughly, and bone splinters removed. It’s often your own skin germs which get into the wound and cause an infection.

The bone (and in this case,  bones — the bigger tibia or shin bone, and the thinner fibula which sits behind and to the outside of your leg) get straightened out and lined up. Then a titanium or stainless steel rod is put into the bone to keep it straight as it heals. Sometimes the rod stays forever, sometimes it’s removed months later).

Now comes the worry days. You monitor for infection despite your best efforts to clean the fracture. You keep an eye on circulation since an artery can clot in the days after the leg is fixed. You also look out for something called “compartment syndrome.”

If you feel how much fat is between your shin bone and the skin — you’ll notice there isn’t much. So any swelling in this area can choke off the blood supply, cause leg muscles to die, and nerves to wither. That’s a compartment syndrome. The treatment is a second emergency surgery to slit open the leg to relieve the pressure.

If things go well, you wait for things to calm down, then begin gentle physical therapy, and monitor the healing of bone. You can do plain X-rays but CT scans often are more accurate at measuring the bones knitting together. All this time you are hoping you don’t have “non-union”. That means the bones won’t heal together. A rare but real complication in the tibia.

In some cases, doctors will use a bone stimulator — small pulses of electric impulses to jump-start or encourage healing.

As to putting weight on the leg — no predictions there. But let’s say the initial surgery went great — there are no complications after surgery — there’s no damage to muscles or tendons — everything heals — and you rehab the heck out of it.

In that case, there is the possibility that this is not a career ender. And you might even see him on the court next season. Sure that’s speculation, but we doctors live in a world of optimism and in the hope of the ability of a young body to heal.

Fingers crossed. Prayers said.

————- Monday A.M. Update ——-

Spoke to several colleagues today- all say will never know what caused the leg to fracture like it did. An undetected stress fracture possible, but also simply the tremendous forces placed on a leg with an awkward landing.

No matter, since today Ware is out of bed on crutches. No bearing weight on it — but it’s great to see him up and out of bed so soon. So far, so good. In fact, so far, so great.

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