Russian skier injured at Olympics--update and her prognosis

A day filled with excitement and drama at the Sochi Olympics was marred by news Saturday morning of Russian freestyle skier Maria Komissarova's serious injury.

Komissarova sustained a broken back by dislocating her vertebra during a practice session on the freestyle course. She was taken immediately to emergency surgery, where doctors worked for 6.5 hours to stabilize her condition.

A spokesman for the Freestyle Federation of Russia confirmed through a translator that the injury was "a fracture dislocation" and that Russian President Vladimir Putin had been to see Ms. Komissarova.

"The fact that they took her to the operating room immediately tells us a couple things," says Alex Vaccaro, M.D., Ph.D. at the Rothman Institute. "A fracture/dislocation is a very unstable injury, and it merits immediate surgical intervention. If they waited, it would potentially compromise her eventual outcome."

The spokesman from the Federation went on to say that it would be "three or four days" before any real news on Ms. Komissarova's condition would be available.

"That means she must have a neurological injury," says Dr. Vaccaro. "What you and I don't know is how severe that injury might be. It could be a complete injury with no function  and they want to see if she'll regain that function? We don't know that."

In that case, 3-4 days will not be enough time to give a true picture of Ms. Komissarova's long-term prognosis. "If you have a spinal cord injury, you need a lot more time to see improvement. I've seen patients come in with what appeared to be a complete injury and then slowly regain function starting from the flicker of a toe. Six weeks later, they could move their whole foot."

With severe but incomplete neurological injuries, improvements can be observed for a period of 1-2 years. But if it's a complete neurological injury, "you're not going to see improvement in 3-4 days regardless," says Dr. Vaccaro. "With a severe neurologic injury you need a lot more time to tell whether it might be an incomplete injury, which can manifest itself through leg movement over time. What they're saying is that if we see improvement in 3-4 days, that's a great prognosis, long-term. But if we don't see improvement that soon, it's not the end. It just means more time is needed."

One thing appears certain, however—Komissarova's skiing career is over. "If you go to an operating room with a severe neurologic deficit, you are not skiing again competitively," clarifies Dr. Vaccaro.

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