NFL Week 6 Injury Report: What’s A Fractured Fibula? (Odell Beckham Jr.)

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Our weekly NFL report evaluates injuries to players of local (Patriots, Giants and Jets) or national interest with commentary by a sports orthopedic specialist from the Bone & Joint Institute at Hartford Hospital.

Player: Odell Beckham Jr., New York Giants receiver.

Injury: Left ankle. Although the Giants did not release specifics, Beckham reportedly suffered a high-grade, high-ankle sprain (torn syndesmotic ligament) and a fractured fibula.

How it happened: Beckham landed awkwardly after attempting to make a catch with four minutes left in the Giants’ 27-22 loss Oct. 8 to the Los Angeles Chargers. Beckham also was the subject of our Week 2 Injury Report with a high ankle sprain, the same ankle that’s now broken.

Expected time missed: Beckham, after surgery Oct. 10, will be placed on injured reserve and miss the rest of the season.

Dr. Clifford Rios, Bone & Joint Institute orthopedic surgeon and board-certified in sports medicine: “I would expect a minimum of four months before a return to competition, but it could take longer. Even if a miracle hits and Giants (now 0-5) are playing the first week of February, he wouldn’t have been ready.”

What’s a fibula?: A lower-leg bone that extends from the knee to the outside of the ankle parallel to the tibia (shinbone). It stabilizes the ankle and supports lower-leg muscles. A severe ankle sprain can cause a fibula fracture. It’s a fairly common injury in the NFL. Two prominent quarterbacks, the Raiders’ Derek Carr and the Titans’ Marcus Mariota, suffered a similar injury late last season. Any contact sport — football, soccer or lacrosse — increases the risk of a traumatic fibula injury. If you play a sport that requires sharp twists, such as basketball, you’re also vulnerable. In everyday life, people with hormone disorders, nutritional deficiencies and metabolic disorders are at greater risk.

Where’s the fracture?: That’s the critical question. A fracture in the upper half, though rare, is often allowed to heal on its own. A fracture in the lower half, like Beckham’s, is far more complicated and typically requires surgery.

“This has to do with the mechanism of injury and stability of the fracture, as well as the proximity to the joint surface,” says Dr. Rios. “Most fractures around the upper part of the fibula are actually the result of an injury that started at the ankle.  For example, a severe twisting can cause a fracture around the ankle and the energy travels up the leg and exits near the upper part of the fibula.

“People can also tolerate some malalignment of a fracture in the upper and mid-portion of the fibula.  It is important to restore normal alignment near the ankle to allow normal motion of the ankle and minimize the risk of post-traumatic arthritis.”

Three types of fibula fracture:

  • Caused by injury to the ankle joint.
  • Part of injury that includes a tibia fracture.
  • Stress fracture.

“An acute fracture will generally take longer to recover from than a stress fracture because there has been more disruption,” says Dr. Rios. “The Key to both injuries is allowing ample healing time because the fracture can become worse if stressed too soon.

How a fibula fracture is repaired: Sometimes, an isolated fibula fracture — a classic “twisted ankle” — that doesn’t affect the ankle joint can be treated with a brace, no surgery required. An injury to the inner portion of the ankle, however, can require surgery.

An orthopedic surgeon can manipulate the bone into its proper place and reinforce the bone with a metal plate and screws.

“Plate and screw fixation is the standard,” says Dr. Rios. “Generally, these are left in, but it is not uncommon to remove them because once the swelling goes down this hardware can be prominent and may be bothersome.  Hardware removal does carry some risk of refracture when the bone is stressed, so it is important to weigh the risks and benefits of removing the plate and/or screws.”

How painful is a broken fibula?: Probably not as painful as a fracture of a load-bearing bone like the tibia.

Beckham appeared to be in considerable pain and sobbing as he left the field on cart.

“Not all fractures are created equally,” says Dr. Rios, “but they still hurt.  The fibula bears approximately one-sixth of the body’s load.  The tibia bears the majority.  An isolated fibula fracture can, in some circumstances, be considered like a bad ankle sprain.”

Because the fibula is not a weight-bearing bone, your doctor might allow you walk as the injury recovers. You also might be advised to use crutches, avoiding weight on the leg, until the bone heals because of the fibula’s role in ankle stability.

Fibia fracture vs. knee injury (torn ACL): A fractured tibia will cost an athlete playing time in the short term but usually has no long-term effects. A serious knee injury to a NFL running back or receiver can alter a career.

“Athletes tend to recover better from fracture than a ligament or tendon injury,” says Dr. Rios. “Fractures heal without a scar and bone heals to bone better than it heals to ligament or tendon. A key distinction in a fracture around a joint is whether the cartilage — protective covering of the bone at a joint surface — got injured. A bad cartilage injury in association with a fracture is going to be much more detrimental to career length.”

Rehab: It’s a slow recovery, starting with minimal weight on the injured ankle. Your physical therapist will recommend exercises that help tissues heal by enhancing blood flow. You can also work out, even with one leg, by doing water exercises, using an elliptical machine with the injured leg supported, rowing and yoga.

“Typically, it’s non-weight-bearing or limited weight-bearing for six weeks,” says Dr. Rios. “Most fractures will have some degree of protected weight-bearing for 10-12 weeks, then at least another month to fully rehabilitate.”

Dr. Clifford Rios, a sports medicine surgeon with Orthopedic Associates of Hartford, is Site Director for orthopedic resident education at the Bone & Joint Institute. Click here to find out why the Bone & Joint Institute is the athlete’s choice, with a Motion Lab for performance analysis, the area’s most comprehensive sports rehabilitation facility and 30 fellowship-trained orthopedic surgeons.


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