Steve Mora MD Talks About MMA Injuries: Anderson Silva Leg Injury UFC 168 Dec @8, 2013
Anderson Silva suffered a terrible tibia fracture today after his low kick was checked by Weidman. The force led to Silva’s leg fracturing in what appeared to be a distal tibia fracture. Silva tried to stand on the injured leg but immediately fell and experienced excruciating pain. The match was immediately stopped.
This is what will probably happen next:
Silva’s leg needs to be immobilized to prevent further injury to the soft tissues. This is accomplished by supporting the leg to keep it from thrashing around and then applying a splint. If you saw the fight you may have noticed the ring doc supported Silva’s broken leg right away. It looked to me as though he pushed the fracture spike down with his thumb to keep it from puncturing through the skin. The next step is to get the medic to apply a cardboard or inflatable splint.
If the fracture is not stabilized the sharp fracture ends will cause further damage to the surrounding muscle and possible puncture through the skin. Stabilizing the fracture is good for soft tissue damage control and for pain control.
Once Silva arrives to the hospital ER the leg will be further assessed with a physical exam and X-rays. It will be placed in a better long leg splint and elevated. The physical exam is important because it will further define the injury. For example, did a bone spike poke through the skin? Is there vascular or nerve damage? Is the fracture near the middle of the bone or near the end?
When fractured bones break through the skin, they are called open or compound fractures. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for complications and take a longer time to heal.
Silva will be given intra-venous pain medication. He will have an IV placed and will be given IV fluids. He will not eat in preparation for surgery. Surgery will probably be done 12 hours from his last meal.
The lower leg is made up of two bones: the tibia and fibula. The tibia is the larger of the two bones. It supports most of your weight and is an important part of both the knee joint and ankle joint.
Example of a distal tibia fracture
Silva’s fracture is probably going to turn out to be a unstable type of tibia fibula fracture. These unstable fractures are usually treated with surgery. Some tibia fractures can be treated with a cast however those are the types that did not displace or angulate much. Silva’s leg was grotesquely deformed so I suspect it will be unstable and will require surgery. The current most popular form of surgical treatment for tibial fractures is intramedullary nailing, aka IMN. During this procedure, a specially designed metal rod is inserted from the front of the knee down into the marrow canal of the tibia. The rod passes across the fracture to keep it in position. The IMN is ran down the canal and crosses the fracture. Once it is in good position it is locked in place with screws above and below. This technique is the preferred technique because it is minimally invasive and has a high success rate.
In some cases tibial fractures can be treated with screws and plates. This is usually the case when the fracture is so close to the ankle that a rod cannot do the trick. Silva’s fracture seemed to be near his ankle so its possible he may require plates.
Example of a distal tibia fibula fracture treated with plate screws and ex fix
We will find out in the morning.
Once the surgery is done he will be admitted for observation. His leg will be elevated and closely monitored for excessive swelling. Excessive swelling can lead to a serious complication known as compartment syndrome which is something that would require further surgery.
Once Silva is out of the woods regarding the swelling he will be discharged with crutches. At this point he is on the road to healing. Tibia fractures can take up to 3 months to heal solidly. Sometimes they take longer. It depends a lot of how much surrounding soft tissue damaged occurred at the time of injury.
Once the fracture is rock solid he will have a serious discussion with his surgeon about whether or not to remove the hardware (IMN vs Plate). In non combat athletes the metal usually does not need to come out. There are pros and cons to removing the metal. If the metal is removed he will have to wait for the holes and tunnels in the bone to fill in before exposing himself to excessive forces.
Once the bone is healed he can start training. When will that be? In my experience taking care of combat athletes its 6-12 months. However no 2 patients are the same. Even though he is in his late 30s he still has an excellent chance of healing. I do not think being 38 makes a big difference in terms of recovery. I would not count him out yet.
I hope this information helps.
At this moment my prayers are with Silva and wish him a uncomplicated recovery.
Steve A. Mora, M.D.
Orange County Orthopaedic Surgeon specializing in sportsmedicine, knee, elbow and shoulder.
I focus on injuries related to sports related trauma, combat sports and soccer injuries. I perform mesenchymal stem cell injections derived from bone marrow and platelet pure plasma. For appointments please call 714 639-3750. For info regarding my practice you can also visit me on youtube.com
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