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Week Seven Injury Analysis: Two "Iron Men" Hurt

Jeff Stotts

Jeff Stotts works as a Certified Athletic Trainer (MAT, ATC, PES, CES). He won the 2011 Best Fantasy Football Article in Print from the Fantasy Sports Trade Association.

Violent helmet-to-helmet hits were down in Week 7 and not a single flag was thrown for an illegal hit after the NFL front office placed new restrictions on hitting defenseless players. However even a rule change couldn't protect two "iron man" quarterbacks.

Minnesota's Brett Favre could see his consecutive games started streak end at 291 as a recent MRI revealed not one, but two fractures in his left ankle.

The first fracture is a stress fracture. The break is being classified as a compression injury, meaning the fracture resulted from the pressure of two bones being compacted together. Stress fractures need rest to repair and can become chronic, unstable injuries if an athlete attempts to play through the associated pain.

Favre's second fracture is an avulsion fracture of the calcaneus, more commonly known as the heel bone. Avulsion fractures occur at the attachment site of a tendon or ligament. When the ankle is twisted or powerfully forced in a particular direction, the resistance of the ligament is often greater than the strength of the bone and a piece of bone is torn from its cortex. Specifics surrounding the location of the break have been vague but generally avulsion fractures occur on the inside of the foot at the medial malleolar osteoligamentous complex (MMOLC). The MMOLC consists of several ligaments including the deltoid and spring ligaments. These ligaments work with the capsule of the joints to maintain stability between the bones of the foot, particularly the calcaneus, talus, and navicular bones. Avulsion fractures to the area can make the ankle unstable, and while surgery is not required it is generally carried out at some point.

Favre's left ankle was a cause for concern entering the season. He underwent a debridement procedure this past offseason and received a lubricant injection prior to Week 1. He is currently wearing a walking boot on the ankle and his availability for Week 8 against the Patriots remains in question. It is hard to bet against Favre but it seems his normally dependable body is finally had enough. Even if he elects to play, Favre is a risky start against New England. During the preseason I advised anyone drafting the veteran to have a suitable insurance policy in case the ankle flared up. Hopefully my warnings did not fall on deaf ears and fantasy owners are not scrambling for a replacement.

While Tony Romo's 29 straight starts are a mere fraction of Favre's streak, the
Cowboys quarterback has been a dependable fantasy weapon since taking over for Dallas. Unfortunately the streak will come to end this Sunday as Romo suffered a broken clavicle, better known as the collarbone, in the Cowboys Monday night defeat to the Giants. Romo was injured early in the second quarter when Giants linebacker Michael Boley tackled the QB, driving his left shoulder into the ground. The tackle was the perfect mechanism of injury for a clavicle fracture and Romo is lucky to have avoided injury to his acromioclavicular (AC) joint. A CT scan performed on Tuesday revealed the break will not warrant surgery to stabilize but will sideline Romo six to eight weeks. The timeframe would make it possible for Romo to return just in time for the playoffs of fantasy football. However with Cowboys team mired in a dreadful 1-5 start and their playoff hopes all but smashed, it is hard to see the team risking reinjury to their franchise player. Veteran Jon Kitna will takeover as the starter and is a decent option in leagues that require multiple quarterbacks. However the veteran has not started since 2007 and could struggle early on, despite the numerous offensive weapons in Dallas.

San Francisco's Alex Smith is also nursing an injury, a sprained AC joint on his left shoulder. The injury is similar to the one sustained by Detroit's Matthew Stafford and detailed in last week's column. The AC joint is located where the collarbone, meets the shoulder blade at a bony process known as the acromion. A sprained AC joint can lead to an unstable shoulder complex and limit the range of motion for an athlete. Fortunately the injury occurred to his non-throwing shoulder, which should minimize the time lost for Smith. However he remains a giant question mark entering Sunday's game in London and it seems likely that David Carr will get the start.

Jacksonville will welcome their signal caller back to the fold in Week 8 as quarterback David Garrard has completed a neurological exam and been cleared to return to practice. Garrard sat out his team's loss to the Chiefs with a concussion. However keep in mind Jacksonville' right tackle Eben Britton suffered a torn labrum in Week 7 and is lost for the season. Britton's right shoulder dislocated twice during the game and ultimately will require surgery to repair. Jordan Black will replace Britton on Sunday and be faced with the task of blocking DeMarcus Ware and the rest of the Dallas defense. Garrard could be in for long afternoon and Maurice Jones-Drew owners should also be aware of the gapping hole on the right side of the Jaguars' offensive line.

St. Louis running back Steven Jackson is recovering from surgery performed Monday. The former Pro-Bowler had two pins inserted into his left ring finger to stabilize a fracture sustained in his team's loss to Tampa Bay. Jackson played the entire game, amassing 110 rushing yards. The Rams are optimistic he will play on Sunday and it's hard to argue with that sentiment. Jackson played the majority of last season with a significant back injury so it seems likely he will fight through this issue as well. Fortunately Jackson carries the ball primarily in his right hand but the injury could make him susceptible to fumbles if he has to switch hands. The hand could also be vulnerable if the running back were to attempt a stiff arm. Jackson should be utilized if he is cleared to play especially with a Carolina defense that gives up 129 rushing yards a game next on the schedule.

Jeff Stotts is a Certified Athletic Trainer, MAT, PES and the Injury Analyst for You can follow him on twitter @RotoWireATC.