5 Reasons Why Kevin Ware's Injury is not the Same as Joe Theisman's
Joseph Yu M.D.
#1 The Force of Injury
Kevin Ware landed awkwardly on his foot as he tried to defend a three point shot. He fractured the tibia and the fibula most likely at the same level. In contrast, Joe Theismann’s injury was much more forceful. He was crushed by two opposing football players. His surgeon stated that the membrane around the bone (periosteum) had been stripped away. It is probable that his fracture was more comminuted or broken into several smaller pieces. This can impair bone healing.
#2 Open Injury with Potential for Contamination
Both injuries were “open.” This means the area inside the skin which includes the bones, muscles, and soft tissues are exposed to the outside environment. In Theismann’s case, he was injured on a football field with grass and dirt. These elements can cause contamination and lead to infection which can result in poor healing. Ware’s injury was on a basketball court with less chance of contamination.
#3 Ware was younger than Theisman at the time of their respective injuries.
Youth leads to faster healing and better recovery.
#4 Better Methods of Treatment
In 2013, an intramedullary rod is used for most fractures of the tibial shaft. In the 1980’s, rods were just starting to become more popular with these types of fractures. In 1985, Theismann’s fracture was surgically cleaned to prevent infection and then placed in a cast. At that time, this was the standard of care. In this day and age, Theismann’s fracture would probably undergo an intramedullary rod.
#5 Better Surgical Technique
Just as implants have improved over the years, the skills of an orthopedic surgeon are better than ever. A rod can be placed through a 3-5 cm incision at the front of the knee and passed through the canal of the bone. Two small one cm incisions are made on the sides of the leg to place interlocking screws; these are screws placed through the bone and the holes in the rod. They prevent rotation and shortening of the bone.
I polled six sports medicine trained orthopedic surgeons and asked them if a high level athlete would have a better prognosis after treatment for an open tibia fracture versus an anterior cruciate ligament (ACL) tear. Their answers were evenly split. If I posed the same question and removed the possibility of infection, five out of six surgeons said that the patient with the open tibia fracture would have a better prognosis.
In the open tibia fracture, the dreaded complication would be an infection and this could lead to failure of the fracture to heal or a chronic bone infection. On the other hand, the main complication associated with an ACL tear is a rerupture or arthritis in the future. If no infection occurred, surgeons favored the patient with the tibia fracture because bone heals reliably well. One surgeon remarked that “it is easier to get bone to heal. There are too many variables in the joint.”