Treating traumatic game-time injuries

As the world recently watched Kevin Ware’s horrific leg injury, many questions arose. How much pain is he in? How does this happen? Will the doctors be able to fix it? Will he return to basketball? 

Behind the scenes, the medical team (usually consisting of a certified athletic trainer and team physician) is only thinking about attending to the injury quickly so there is no further damage and the athlete is made as comfortable as possible. Only later will they try to figure out why this happened and if something like this could be prevented in the future.

When an athlete goes down during a game, the certified athletic trainer (ATC) is usually the first one to their side. When the injury is as serious as a compound fracture, the team physician will join the athletic trainer immediately and they will work as a team to attend to the athlete. In collegiate athletics, the team doctor attends the games, but the athletic trainer usually covers practices alone. Many serious injuries occur during practice, so it’s important that the ATC is well trained and has an action plan in place for these types of events. Most ATCs are cool under fire and manage emergencies very well.

When attending to an injury like Kevin Ware’s compound fracture, the medical team must first make sure there has been no damage to the blood supply and nerves going to the leg. Pulses on the foot and sensation below the injury are checked. If these tests are abnormal, the athlete is at risk of losing his foot.  If the pulse and sensation is intact, the leg will be quickly splinted and the athlete is sent for emergent surgical care. This is a very painful injury and there can be considerable bleeding. An intravenous line is placed in his arm so fluids and pain medicine can be given.  Once at the hospital, the athlete undergoes surgical treatment that involves cleaning the open wound to prevent infection and stabilizing the fracture.

The most common surgical treatment for this type of fracture is a titanium intramedullary rod placed down the center of the tibia to align the fracture and help with healing. The problem with a compound fracture is there has been damage to the muscle and the skin, so recovery can take longer. A full recovery to their pre-injury level is in question.

The Kevin Ware injury stresses the importance of the medical team knowing their athletes. The team must observe their athletes play and discuss any potential medical issues they may have to prevent a season-ending injury.

Although these fractures can occur when an athlete lands a certain way, often there are some pre-injury symptoms that can hint to an impending injury. If he was having some leg pain, often mistaken for ‘shin splints’, this could have been related to a developing stress fracture. A stress fracture is weakening of the bone which can lead to a full fracture like the Kevin Ware injury. The medical team can’t prevent every injury, but a trusting relationship with the athletes is vital to a healthy season.


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