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Sports Injury Project

● Dislocated Ankle and Fractured Tibia
● What is the medical name for the injury?
Fractured Medial Malleoli
● What specifically causes the injury?
- The ankle can dislocate as a result of a fall, motor-vehicle crash, or sporting injury.
Forces are placed on the ankle that cause the bones to fracture or the ligaments to tear,
resulting in the dislocation.​ ​The strength and complexity of the ankle, due to all of the
ligaments that hold the ankle in its place, requires a large amount of force and indirect
trauma to coerce the ankle to flex abnormally (Dislocated). ​When the foot rolls inward, it
causes a compression of the medial malleolus on the inner side of the ankle. When the
foot rolls out, this pulls tension on the medial malleolus, which can cause a fracture
(Cluett, Jonathan).
● What specifically gets damaged from this trauma?
- The ankle is a hinge joint that connects the lower leg to the foot. The tibia and fibula of
the leg come into contact with the talus of the foot, forming the ankle mortise. The
majority of the weight bearing in the ankle occurs between the tibia and talus. While the
shape of the mortise helps align the ankle joint, the surrounding ligaments are very
important in providing stability. When the ankle is dislocated, the tibia is fractured or
broken. However, since a large force is required to break the tibia, ​ ​a medial malleolus
fracture often occurs in combination with other injuries such as a sprained ankle or other
fractures of the foot, ankle or lower leg (PhysioAdvisor). ​For the ankle to be dislocated
ligaments on one side of the ankle are completely ruptured. The outside ligaments are
usually the ones that end up ruptured (Dislocated).
● How is this injury repaired/ How does it heal?
- Surgery might be necessary to treat the injury. During this surgery, the doctor will put the
bones back in place to let them heal correctly, or he/she may use special plates and
screws to keep the bones in place. This is called internal fixation. After the leg has
healed a bit, the doctor may prescribe a removable brace or splint. This is so the patient is
able to start physical therapy. These exercises will help restore and keep the range of
motion and strength. It is likely that a person will need to use crutches or a cane for
several months after the injury. The doctor might also prescribe medicine in order to
prevent blood clots in the leg while recovering. This is called a blood thinner. The patient
might also need antibiotics if their injury caused a break in the skin​. ​If there is a wound, it
should be covered with wet sterile gauze. Emergency medical personnel will stabilize the
ankle with a splint. A person may also be treated with a short leg cast or a removable
brace. If there is any damage to nerves or blood vessels, an orthopedic specialist will
need to reset the damaged bones as soon as possible. They will realign the bones without
surgery in the form of a closed reduction (Hecht, Marjorie).
Autumn McCool is in the light color ​Natalie Williams is in the black color
Autumn McCool is in the light color ​Natalie Williams is in the black color

● Article 1 & Summary:

○ Article:
This special edition of our weekly injury report reviews Gordon Hayward’s devastating injury
less than 7 minutes into his first regular-season game Oct. 17 with the Boston Celtics after
signing a four-year, $128 million contract. Sign up for our weekly NFL report (click here and
scroll to “Free email newsletters”), which 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: Gordon Hayward, Boston Celtics small forward.

Injury: Dislocated left ankle, fractured tibia.

How it happened: Hayward lost his balance after taking a back-door lob pass from Kyrie Irving
and landed awkwardly on his left leg. The severity of his injury was apparent immediately.

Expected time missed: After some pre-surgery speculation that Hayward could return as quickly
as 4-6 months, his agent offered a more sober evaluation after the surgery Wednesday at New
England Baptist Hospital in Boston. It’s now expected that Hayward will miss the entire season.

Dr. Clifford Rios, Bone & Joint Institute orthopedic surgeon and board-certified in sports
medicine: “Four to six months can be realistic for a bone of the upper extremities.
Lower-extremity fractures typically require a minimum of three months even before full
weight-bearing, then need another several months to rehabilitate back to elite function.”

What is a dislocated ankle with fractured tibia?: It’s a rare, traumatic injury, when the bones that
form the ankle joint and connect the lower leg — the talus (ankle) and tibia — are no longer
anatomically intact. You can see that in the obvious deformity in Hayward’s lower leg
immediately after the injury.

The tibia is one of the lower leg’s two long bones, with the fibula at its side. They join at the
talus to form the ankle joint, which includes connective tissue around the joint (the joint capsule)
and ligaments that increase stability. A “clean” break, with no damage to surrounding tissue and
ligaments, is the best-case scenario here.

“The key with any fracture,” says Dr. Rios, “is how much damage occurs at the joint surface.
The bones will heal well but severe injury to the cartilage, the protective covering at the joint
surface, can cause permanent loss of function due to post-traumatic arthritis.”
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A dislocated ankle typically includes a fracture of the distal ends of the tibia (medial malleoli)
and fibula (lateral malleoli), with possible ligament damage. These injuries are caused by trauma
from a sports injury, car accident, serious fall or other incident. The force of the injury separates
the bones, often with the foot and ankle facing downward (plantarflexion). The ankle is then
pushed inward (inversion) or outward (eversion).

If you have both a dislocated ankle and a fractured tibia, it does not complicate your recovery.

“No difference,” says Dr. Rios. “They heal together at the same rate.”

How is the injury repaired?: X-rays, and possibly an MRI or CT, confirm the diagnosis. After the
ankle bones have been “relocated” to their original alignment — a critical step because, done
improperly, it can damage surrounding nerves, ligaments, cartilage and other bones — doctors
can then repair the ankle surgically.

“The first step with a dislocation is getting the joint surface aligned,” says Dr. Rios. “If the skin
is not too swollen, immediate fixation with plates and screws is typical.”

Rehab: Recovery from this injury takes time and a lot of hard work.

“The first stage is no weight-bearing and allowing healing of the fractures,” says Dr. Rios.
“Some motion may be allowed. After 6-8 weeks, you may increase weight-bearing to 50 percent.
Full weight-bearing is typically after around 3 months. You can begin running after four months
or more.”

Can Hayward return to his previous athletic form?: “I would need to see the X-ray,” says Dr.
Rios. “The biggest determinant is how much damage occurred to the cartilage. If cartilage
damage was minimal he may have several strong years remaining.”

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.
○ Summary:
During the first game of the season, Gordon Hayward lost his balance while trying to
shoot a shot and fell awkwardly on his left leg. During his fall, he dislocated his ankle and
fractured his tibia. His traumatic injuries caused him to be predicted to miss the entire season.
Dr. Clifford Rios, a sports medicine surgeon, predicted Hayward’s injury to take 4-6 months to
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heal, and for him to play again in the regular season. The deformity of Hayward’s injury was
immediately noticeable after the injury occured. In his case a long with very few others, the
dislocation of the ankle and the fracturing of the tibia is a very rare injury. Fracturing of leg
bones along with a dislocated ankle does not complicate a person’s recovery. In order to confirm
that a person has sustained this injury, tests such as X-Rays, MRI, and CT can be performed.
Relocating the ankles bones during recovery can be very risky. If they are not relocated correctly
they can damage surrounding nerves, ligaments, cartilage, and other bones. After the doctors
have been able to relocate the ankle bones, they can begin to try to repair the ankle surgically.
The first step in this process is getting the joint surface aligned. The first step to recovering is to
not allow the patient to bear any weight in order to allow healing of the fractures, on different
occasions only few motions are allowed. The amount of years that your ankle can be strong is
determined by the damage of the cartilage. All of the science in this article was verified by the
Dr. Clifford Rios, a sports medicine surgeon with Orthopedic Associates of Hartford.
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● Article 2 & Summary:

● Article:
Gordon Hayward's ankle injury and road to recovery, as explained by a medical expert

The NBA's hyped season-opening game between the Cleveland Cavaliers and Boston Celtics
was derailed within a few minutes. New Celtics star Gordon Hayward went up for a lob, bumped
into LeBron James in mid-air and landed awkwardly. The result was a gruesome lower leg injury
that the Celtics are calling a dislocated ankle and fractured tibia.

To get a better understanding of Hayward's injury and what lies in store for him during his
recovery, CBS Sports spoke with certified athletic trainer Jeff Stotts. In addition to his work in
the field, Stotts runs his own website, InStreetClothes.com, and serves as an injuries analyst for
CBS Sports partner Rotowire.com.

CBS: Ankle dislocation and tibia fracture is what they're calling it. And obviously, tibia fracture
(a broken shinbone) makes sense. That's clear to people. But for the dislocation … you have the
three bones -- the tibia, fibula and talus -- that make up the ankle joint. What exactly do we mean
when we say it dislocated?

Jeff Stotts: So based on the pictures we saw, you can see the talus slipped out from underneath
the ankle mortise of the tibia and fibula, the kind of roof that those two bones form over what we
consider the ankle joint. Likely in that process is where the bone broke. Right now all we know
is tibia, we don't know if there's any damage to the talus. And then they haven't described any
soft-tissue injuries that likely occurred. Because to have something so violently forced into that
direction, you know you have stabilizing ligaments to try and prevent that, but if it was out, and
stayed out like it reportedly did, until they reduced it, you're looking at some level of soft tissue
damage. We just don't know to what extent yet.

CBS: You mentioned how they reduced it right there on the court. Is that a good sign they were
able to do that immediately?

JS: Yeah, I mean it's important to do it early. You want to make sure the vascular structures
(nerves, arteries) that run in close proximity to the tibia in that area aren't compromised. The
ankle is one of those joints that's a little harder to relocate than a finger, or you know a lot of
times shoulders go back into place relatively easily. The ankle can be difficult, but that's why
they have the doctors come to the games.

But it will also provide some pain relief for Hayward. The guy, obviously reacted when it
occurred, but by the time they were carting him off the floor, he was pretty stoic. For a guy that
had this catastrophic, gruesome looking injury, I was pretty impressed with his composure.

CBS: In regards to the soft tissue injuries you mentioned earlier, Mike Gorman, the Celtics
broadcaster, reported that sources told him it was a clean fracture, with no ligament or blood
vessel damage. If that is indeed true, why is that good news for Hayward?
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JS: Connective tissue can take a long time to heal, especially if it's repaired. It's one reason why a
broken bone sounds worse than a torn ACL, but you have to go in and repair that ligament.
Connective tissue, once it's past a certain point, it's hard to get it back to its original strength, it
takes time, and often requires surgical intervention.

If he did avoid ligament damage, the potential for there not being an ankle reconstruction on the
lateral aspect or medial aspect as well is good. They don't have to worry about reconstructing
those ligaments. They can just worry about aligning the pieces of bone and making sure they're
stable to allow for a proper union of the bone fragments.

CBS: To help with that do you think they'll have to put in any plates or hardware?

JS: It's very likely they're gonna put plates and screws. It's a little bit different than the Paul
George thing where they put the rod in the middle because you just want to stabilize the injury
site. Here you're talking about, because of the dislocation, because of the forced rotation of the
bones, likely using a plate and screws to stabilize any of the area. Again that's purely speculation.
There might be some other steps involved depending on the severity of the injury. Those are the
little specifics we're trying to clear up and see what they end up doing.

CBS: Do you think it will be harder for Hayward to come back from this injury because he's a
basketball player? Or, to put it a different way, do you think Hayward being a basketball player
will make his return harder than if he played football or baseball where there isn't as much
jumping?

JS: Yeah, definitely. The ankle is key. You make hard cuts, he plays a position that has a high
demand of lateral movement, so those areas are gonna be stressed. There's a reason the ankles are
the No. 1 injured body part in the NBA. Ankle sprains are way up there, and it's because they're
vulnerable, they're exposed in the sport. It's a problematic area.

He's likely gonna need to spend some time focusing on something like proprioception to make
sure the areas in the body are responding accordingly to manage any kind of additional stress that
will eventually be applied to them. It's gonna take time. It might sometimes be a simple injury,
but it also can be a complex recovery that they'll break up into stages to try to work him back.

CBS: Speaking of that recovery ... Of course, everyone is different, but from your experience
working with athletes, do you think it will be harder for Hayward to return physically or to be
OK mentally with flying through the air like that again?

JS: It's a little bit a both, right? Mental health is a big thing, and that's gonna be something he has
to address, in terms of being back on the court and feeling comfortable. Those two go hand in
hand, mental approach and physical approach. Luckily, by all accounts, Hayward is a mentally
tough guy. He's surrounded by a good medical staff in Boston. He's gonna have plenty of
resources at his disposal to get back, and he's a guy that's been commended for his offseason
approach, too.
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Mentally, I'm not worried about Hayward. Are there going to be challenges? Yes, but I think he's
surrounded by ... and again you know that familiarity with (Celtics coach Brad) Stevens will help
because they have a history there. He's surrounded by the appropriate resources to make a full
recovery.

CBS: I know you aren't a surgeon, but Kobe Bryant advised advising Hayward to be "doing
everything in your power to prepare for surgery, ask all the questions to be sure you understand
fully the procedure so that you may visualize it in your subconscious" Do you think there's any
truth to that being helpful?

JS: I like the athletes that ask questions. You want them to be informed, because, we talked about
that mental aspect of it. It helps them be involved in the process. A lot of these guys are habitual
and meticulous with their approach to rehab and working out generally even when they're
healthy. They want to know why they're doing it.

Steve Nash is a guy that was always on point with, he knew everything about his injuries,
biomechanically, just hearing him talk about his injuries. Kobe was the same way. Those guys,
the more information you have, it's gonna make things easier to report. You know if you see
something pop up, "Oh hey, I'm feeling this. Or, this doesn't feel right, could it be this?" It's open
dialogue between everybody involved medically and the player himself because nobody is gonna
get as much information as the player, because they're listening to their body.

CBS: Lastly, what's a best-case scenario here for Hayward in terms of coming back?

JS: It's difficult to speculate given there's still so many unknowns. But I think it's likely gonna be
12 weeks at least based on what we have right now. He'll probably be evaluated at that mark.
There's an outside chance he's able to play again this season, but again the only other example I
have in my database, the injury occurred in November and the player missed the final 68 games
recovering. He's going to be up against it.

Is it a career-ending injury? By no means, from what we can tell. But he's gonna be hard-pressed
to get back this season. And just because, again, it's an injury of high magnitude, you want to
make sure he's returning at 100 percent and not running the risk of some secondary injury or
some other setback.
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○ Summary:
- In the few minutes of the opening game between the Cleveland Cavaliers and the Boston
Celtics Gordon Hayward jumped up, bumped into LeBron James in and landed
awkwardly on his foot. This resulted in a dislocated ankle and fractured tibia. CBS spoke
with Jeff Scotts, certified athletic trainer. At the moment of this interview, all that Scotts
knew of about the injury was that he had damage to the tibia, but there was unknown
damage to the talus. The doctors at hand put the dislocated ankle back while he was on
the court, and Scott says that this was a good thing for Hayward because of the
importance of doing it early due to how complicated it is to put back in. It is noticed that
it is a clean fracture, meaning that there will be no need for the healing of ligament tissue,
which takes a long time. Despite this, it’s' very likely they're going to have to put plates
and screws in in order to keep it stable. Scotts believes that Hayward has the mental
capacity to bounce back from this injury.
● Glossary:
○ Talus: the large bone in the ankle that articulates with the tibia of the leg and the
calcaneus and navicular bone of the foot
○ Calcaneus: the large bone forming the heel
○ Navicular: a boat-shaped bone in the ankle or wrist, especially that in the ankle
between the talus and the cuneiform bones
○ Cuneiform: any of three small bones of the tarsus situated between the navicular
and the first three metatarsals
○ Tarsus: a group of small bones between the main part of the hindlimb and the
metatarsus in terrestrial vertebrates
○ Distal: situated away from the center of the body or from the point of attachment.
○ medial malleoli: the prominence on the inner side of the ankle, formed by the
lower end of the tibia
○ lateral malleoli: the prominence(the state of being important or famous) on the
outer side of ankle, formed by the lower end of the fibula
○ Plantar flexion: movement of the foot in which the foot or toes flex downward
toward the sole
○ Inversion: a movement in which the plantar surface (sole) of the foot rotates
towards the mid-line of the body
○ Eversion: movements that tilt the sole of the foot away from the body
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○ MRI: a diagnostic technique that uses magnetic fields and radio waves to produce
a detailed image of the body's soft tissue and bones
○ CT: Stands for a Computed tomography scan, The CT scan can reveal anatomic
details of internal organs that cannot be seen in conventional X-rays. The X-ray
tube spins rapidly around the patient and the X-rays strike numerous detectors
after passing through the body
○ Dislocation: ​injury or disability caused when the normal position of a joint or
other part of the body is disturbed
○ Ankle Mortise: the hinge that connects the ends of the tibia and fibula to the talus
○ Ligament: a short band of tough, flexible, fibrous connective tissue that connects
two bones or cartilages or holds together a joint
○ Reduce: restore a dislocated part to its proper position by manipulation or surgery
○ Vascular Structures: a structure composed of or provided with blood vessels
○ Clean Fracture: ​ ​a fracture or broken bone that has one identifiable fracture line as
opposed to many with multiple fracture fragments
○ ACL: one of the four main ligaments within the knee that connect the femur to
the tibia. The knee is essentially a hinged joint that is held together by the medial
collateral (MCL), lateral collateral (LCL), anterior cruciate (ACL) and posterior
cruciate (PCL) ligaments.
○ Lateral aspect: the side of the body or a body part that is farther from the middle
or center of the body. Lateral refers to the outer side of the body part, but it is also
used to refer to the side of a body part.
○ Medial aspect: Pertaining to the middle; in or toward the middle; nearer the
middle of the body
○ Proprioception: The ability to sense stimuli arising within the body regarding
position, motion, and equilibrium
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Works Cited
Cluett, Jonathan. “Fractures of the Inner Side of the Ankle Joint.” ​Verywell Health​,
www.verywell.com/medial-malleolus-fracture-2549418​.
“Dislocated Ankle.” Virtual Sports Injury Clinic,
www.sportsinjuryclinic.net/sport-injuries/ankle-pain/acute-ankle-injuries/dislocated-ankle.
Hecth, Marjorie. “Medial Malleolus Fracture: Treatment, Recovery, and More.” ​Healthline​,
Healthline Media, ​www.healthline.com/health/medial-malleolus-fracture​.
Hunt, Kevin. “A Medical Look At Devastating Injury To Celtics' Gordon Hayward.” Health
News Hub, 16 Feb. 2018,
healthnewshub.org/health-news-hub/top-news/medical-look-devastating-injury-ce
ltics-gordon-hayward/.
Maloney, Jack. “Gordon Hayward's Ankle Injury and Road to Recovery, as Explained by a
Medical Expert.” ​CBSSports.com​, 18 Oct. 2017,
www.cbssports.com/nba/news/gordon-hayward-ankle-injury-and-road-to-recover
y-as-explained-by-a-medical-expert/.
“Medial Malleolus Fracture - Fractured Medial Malleolus.” ​PhysioAdvisor​,
www.physioadvisor.com.au/injuries/ankle/medial-malleolus-fracture/​.