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Kevin Ware cleared to travel to Final Four

Ware’s talks to ESPN after injury…

By now we have all seen or at least heard about the dramatic and unexpected injury suffered on Sunday by Louisville guard Kevin Ware. This type of injury, an open tibia shaft fracture (fracture of the main bone of the lower leg in which the end of the bone protrudes out of a cut in the skin), is very rare in the sporting realm. It is, however, common in high energy trauma such as motorcycle and motor vehicle accidents. Because the injury is unusual for what appeared to be a routine landing while contesting a shot, many orthopedic specialists have suggested that there may have already been some sort of abnormality or Ware’s tibia such as an undiagnosed stress fracture or some type of bone cyst. Ware himself has yet to report any pre-existing pain or symptoms which would indicate the presence of a weakened spot in the bone.

Ware was reportedly treated surgically the night of the injury by placing a titanium rod on the inside of the tibia bone, which is hollow. This works essentially like an internal cast. The open wound was then closed and sutured, which is not always possible in these injuries, and can sometimes require complex plastic surgery procedures to transfer or rotate other muscles and skin grafts over the open wound to cover the bone. While early reports are encouraging, Ware likely has a long road ahead of him. The biggest challenges he faces in the upcoming weeks and months are to get the wound to heal successfully, prevent infection of the wound or bone, and get the bone to heal. This process can take up to 4 months, at which point more aggressive sport-specific rehabilitation can began. Undoubtedly he will began other forms of rehabilitation even before that which won’t put as much stress on the healing bone, such as range of motion and strengthening exercises, bicycle work, and possible swimming pool exercises. Running and jumping will have to wait until the bone healing is satisfactory.

In some cases, because open tibia fractures have lower healing rates than less complex fractures, a bone stimulator device may be used to optimize healing potential. This is an external ultrasound or pulsed electromagnetic field device that quietly sends signals to the fracture site to speed up the healing process. The titanium rod that has been placed in the leg is usually left in place forever, but can be removed later on if it causes irritation.

As do the rest of you I am sure, we wish Kevin Ware a speedy and uneventful recovery.

Tune in to 97.5 FM at 4:40 PM Wednesday and 1560 AM at 4:40 PM Thursday to hear me discuss more on this type of injury, treatment, and the recovery involved.

Written by Vishal Michael Shah, M.D.

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