Olympic gymnast fractures tibia in gruesome sports injury

French gymnast Samir Ait Said sustained a tibia fracture this past week while competing at the Olympic games in Rio. It was a gruesome reminder about the hazards our athletes face when participating in competition. Athletes at these levels push their bodies to the limit, testing the extremes of human capacity and function.

From the analysis of the video, Samir most likely sustained a transverse or oblique tibia shaft fracture involving the fibula. This is very similar to the injury Kevin Ware sustained a few years back while playing in the Elite 8 of the NCAA tournament. Kevin has come a long way since his original injury. His injury and recovery where documented in a Good Morning America segment.

Tibia Fracture Statistics

Tibial shaft fractures are the most common long bone fracture in adults. Epidemiological data from Edinburgh, UK, suggest an annual incidence of 2 fractures per 10,000 population. The commonest single cause in this series was motor vehicle accidents (>50% of fractures), followed by sport (predominantly soccer). In this series, 24% of the fractures were injuries where the skin around the fracture was disrupted and bone was exposed.

Mechanism of Injury

The tibial bone is one of the strongest in the body. Bones respond and remodel to the mechanical stresses placed on them. For athletes in particular, the tibial bones are much stronger than those in a sedentary persons. To break or fracture the tibia it requires substantial force and energy. With the bone injury there is often accompanying soft tissue injury. In fact, in the case of Kevin Ware, the sharp end of his broken bone cut through the skin and muscle and was exposed.

The other scenario we see tibia fractures in athletes are in endurance athletes that develop tibial stress fractures. This occurs when the rate of cumulative microtrauma to the bone from long distance running exceeds the bodies capacity to remodel and heal bones. In these cases, hair line cracks in the bone gradually progress, and in some cases, if neglected, progress to complete breaks. Although the mechanism of injury is different, the ultimate treatment after the tibia breaks is the same.

Treatment and Recovery

Tibia Fracture Surgery Steps

Bones have an incredible capacity to heal. The guiding principles in the treatment of any long bone fracture includes stabilizing the broken bones, preserving the surrounding soft tissue envelope, and restoring anatomical alignment. The orthopedic physician will generally review the injury pattern and recommend the best means to promote bone healing. For tibia fractures, we often require metal hardware such as rods, plates, and/or screws to hold the broken bones in the correct orientation. Then, generally over 6-8 weeks for healthy non-smokers, the bones grow back together. Once the bone has healed, the hardware is actually accomplished its purpose and is no longer necessary to maintain the bone mechanical stability. The immobilization initially necessary for bone stability produces adjoining joint stiffness and surrounding musculature atrophy. After bone healing is adequate, rehabilitation is focused on regaining muscle strength and coordination. Rarely does the hardware implanted have to be removed. Recovering from a major long bone injury can take anywhere from 4-9 months depending on the severity and amount of rehabilitation needed. If the soft tissue injury is minimal, and no nerves are involved in the injury (often the case after sports related tibia fractures), the bone healing after a tibia fracture is fairly predictable and the prognosis is good. In some ways, a bone injury like a tibia fracture is sometimes easier to recover from than an ACL rupture or rotator cuff tear.

The diagram shown illustrates what a typical tibial nail implant looks like and an overview of the surgical implantation process. The surgery usually takes 1-2 hours. If the associated soft tissue injury is extensive, additional procedures may be necessary to restore the surrounding soft tissues.

Source: “Fractures of the tibial shaft (including acute compartment syndrome)”, McGrath L, Royston S, Article, Surgery, 2007

If you have any questions about tibia fractures, feel free to ask in the comments below. If you would like to discuss your injury directly, please call my office at 281-275-0470

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