Steve Smith of the Carolina Panthers Breaks His Left Forearm
Steven Smith was playing a game of flag football on Sunday at a YMCA when he reportedly fell and broke (fractured) his left forearm. Later that same day, he was taken to the operating room to fix the bone. How much training camp will he miss and will he be ready for the first game of the season?
The forearm has two bones: the radius and the ulna. When you hold your hand with the palm facing the ceiling (as if you are holding a bowl of soup), the radius is on the outer part of the forearm and the ulna is on the inner side of the forearm. both of these bones run from the elbow to the wrist and help to flex and extend the elbow, rotate the forearm in supination (holding a bowl of soup) and pronation (palm towards the floor), and flex and extend the wrist.
The radius is usually broken with a direct blow to the forearm or a fall on an outstretched hand. A break can occur anywhere along the radius, from the area where the bone interacts with the elbow, to the shaft, or to the area where the bone interacts with the wrist. In Steve’s case, he broke his radius along the shaft. This is good news in the long-term, as there should be little effect on the range of motion of the elbow or the wrist.
Individuals who break the radius will experience immediate pain, swelling, loss of motion, and bruising. The bone, once broken, may shift (displace) or stay in relatively the correct position (non-displaced).
For low activity individuals, non-surgical treatments can be applied. This would entail a cast being worn for 6-8 weeks.
For higher demand individuals or athletes, surgery is recommended for a number of reasons. First, the surgery assures that the bone and the fracture are placed in the correct position. Second, with stabilization of the bone, it is easier to start rehabilitation exercises earlier than with a cast. A plate and screws are usually placed on the bone to hold the desired alignment and position of the bone. The plates and screws are almost never removed, unless there is pain from these implants or irritation of the tendons.
The patient below had a plate placed on his left radius and ulna for a both bone forearm fracture. The xray illustrates the type of plates and screws that can be used to surgically fix these fractures.
WHEN TO SEEK MEDICAL CARE
If you suspect a break to your forearm, you should seek medical attention within a few hours. Xrays are used to determine if a fracture/break is present.
RETURN TO ACTIVITIES
With non-surgical treatment, physical therapy is started after the cast is stopped. The cast is discontinued after 8 to 10 weeks, when the bone has shown enough healing on xray to allow for activities. Initially, patients are started on restricted weight bearing exercises, range of motion exercises, and strength training. They are slowly advanced to return to normal activities over the course of 4 to 8 weeks.
After surgery, a period of immobilization is needed with either a cast or splint. The immobilization is maintained for 2 to 6 weeks, followed by physical therapy. In therapy, the patient works on range of motion and strengthening exercises. With surgery, the physical therapy can begin sooner.
Breaks of the shaft of the radius do not usually lead to long-term disability. Since the elbow and wrist are not affected, the range of motion of these joints is usually normal. Unfortunately, occasionally there is some loss of supination (holding a bowl of soup) and pronation (palm facing towards the floor). This can happen if the rotation of the radius is not set correctly in surgery, if a patient heals with a lot of scar tissue, or if a bone bridge grows across the radius and ulna, causing these bones to join and act as one unit.
Based on the above, one would anticipate that Steve will miss the next 4 to 6 weeks of training. He would then start practicing with the team, initially with non-contact, followed by contact activities. If all goes well, he may be ready for Game 1 of the regular season.
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