Surgery let Carson Wentz step up for the Eagles

Carson Wentz, the latest great hope of Philadelphia Eagles fans, might never have landed here if a North Dakota hand surgeon hadn't inserted a variable pitch screw in the quarterback's right wrist last October.

That's the wrist with a religious tattoo - "AO1," for "Audience of One" - on the front.

It's also the wrist that threw three touchdowns with zero interceptions as the Birds won their first two games of the season.

Last Oct. 17, after an early pass for the North Dakota State Bison, Wentz got shoved and landed on his hand. He finished the game with his wrist taped.

What happened next was pivotal in Wentz's becoming a top draft pick.

"There's no doubt about that," said Brian Sennett, chief of sports medicine at the University of Pennsylvania.

Though initial X-rays didn't show a break, higher-quality imaging revealed a non-displaced fracture of the scaphoid, a small bone at the base of the thumb. It's a fairly common injury among athletes trying to break a fall.

The bone's other name, the navicular, might send shivers up the spines of local fans. Philadelphia 76ers center Joel Embiid needed two surgeries and missed two NBA seasons over a fractured navicular in his foot. Embiid, a literally huge hope for the Sixers (he's 7-foot-2), should finally see game action next month.

These breaks can be slow to heal because the blood supply is weak in these areas, explained Hesham Abdelfattah, an assistant professor of orthopedic surgery at Temple's Lewis Katz School of Medicine.

Although the foot's navicular faces much more stress, the scaphoid is "the keystone of the wrist," Abdelfattah said. "All the important biomechanics of the small bones in your wrist are dependent on the health of the scaphoid."

Wentz, who might have played his last game before April's NFL Draft, was bummed by the news.

"I was a little hurt right away emotionally, actually broke my phone," he said in The Road, a North Dakota State video about his senior season (watch it below). "I was just very frustrated ... and thought to myself, my career at [Bison] Nation might be over." (Wentz declined comment for this article, as did the Eagles.)

Getting the diagnosis right was vital, Sennett said. If Wentz had reinjured the wrist before the fracture had been found, he could have suffered a complete break and even death of bone tissue, necessitating a graft, Sennett said.

The choice of treatment was also crucial.

Wentz's hand surgeon, Jason Erpelding of Sanford Orthopedics & Sports Medicine in Fargo, N.D., discussed the case in The Road.

"A lot of times a nondisplaced scaphoid fracture like this will typically heal without surgery," Erpelding said. "The problem is that can ... require an extensive amount of time in a cast, sometimes anywhere from six weeks to three months." That much time out of action "could cause him undue stiffness and weakness in his arm."

With the NFL's scouting combine four months away, Wentz might have let the wrist heal naturally, but Sennett, who has worked for the Eagles and the Sixers, would have advised surgery.

"You can imagine the scenarios where he came out of a cast in January," then had to regain flexibility and grip strength, he said. "He most likely would not have been able to perform at his maximum potential in February and March."

Wentz chose the accelerated path. Three days after the injury, he tweeted: "When adversity strikes you have 2 options ... Back down and quit ... Or push and work that much harder to come back even better.  ... I choose the latter #AO1."

The next day: "Appreciate all the prayers and support! God has a plan and is the ultimate healer! #surgerytime."

Erpelding, citing patient confidentiality, declined to be interviewed. But in The Road, after Wentz is shown looking at hand X-rays, Erpelding describes the fracture: "That's this bone here ... and he fractured it through the midportion. We also call it the 'waist' of the scaphoid." Another X-ray shows a scaphoid with a headless screw, whose different end threads helped to pull the bone together.

Two days after surgery, Wentz, his arm in a sling, told reporters the plan was to cut the temporary cast off the next week, replace it with a hard splint, and "start doing some range-of-motion stuff." Soon, Wentz's "modified workout ... included resistance training and running exercises," according to The Road.

Wentz helped mentor his backup, Easton Stick, who pulled off key heroics of his own, winning three playoff games, including two after Wentz returned to practice.

Finally, almost 11 weeks after surgery, X-rays showed that the wrist had fully healed. On Jan. 9, Carson Wentz passed for one touchdown and ran for two more as North Dakota State won its fifth straight collegiate title.

At the Senior Bowl, Wentz was suddenly a star attraction. ESPN's Todd McShay even began touting Wentz as the best quarterback prospect in the draft.

At the scouting combine, every club sends a team of doctors who examine each player, with X-ray and MRI machines at the ready.

Wentz must have passed with flying colors. As his stock rose, so did the Eagles' position in the draft, thanks to trades. On April 28, after California quarterback Jared Goff was chosen No. 1 overall in the draft, Howie Roseman, the Eagles' executive vice president of football operation, asked Wentz on the phone, "You ready to be an Eagle?"

"This really was a case of medical decision-making that stepped this guy up to be No. 2 in the whole NFL," Sennett said.

Should fans be concerned that Wentz will suffer another fracture?

"The chance of recurrence is very low," said Temple's Abdelfattah.

"Once it's healed the bone is rock solid and it's even stronger, because there's a screw down the center of it," Sennett said. " ... We don't really worry about this bone rebreaking, because it was from a traumatic fall, and not an overuse stress fracture."

If a passer's follow-through whacks a helmet, other hand parts are likelier to get hurt, Sennett said.

Quarterback Joe Namath broke his scaphoid in 1970, but his knees were what haunted the last seven years of his NFL career.

Without the surgery, who knows? Maybe the Eagles would have lucked out in round three. Or maybe Dallas fans would be the ones talking about their "ginger Jesus."

Former staff writer Peter Mucha writes and edits thinkableornot.com.