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Injury Analysis: Tough Breaks

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.

Sometimes injuries come in waves with a set of particular injuries occurring in clusters. The first three weeks of the NFL season have been particularly bad with bone fractures being the dominant issue in Week 3.

Not all bone fractures are created equal, varying in mechanism of injury, amount of damage, and necessary treatment and intervention. A fracture can be open, in which the bone pierces the skin, or closed and isolated to the bone. Bone can splinter into multiple pieces in a break known as a comminuted fracture or it can be an avulsion fracture that happens when a muscle or ligament pulls away a tiny piece of the involved bone. Numerous other classifications exist including linear, transverse, and spiral fractures, each with their own set of complications.

Danny Woodhead
The San Diego running back suffered the most significant fracture in Week 3, suffering a spiral fracture of his ankle in the team's win over the Bills.

Woodhead's fracture is a very specific and relatively rare type of spiral break known as a Maisonneuve fracture. The Maisonneuve fracture, named for French surgeon Jules Germain François Maisonneuve, occurs when the foot is planted while the leg is violently twisted in a motion known as external rotation. The torque on the leg tears the ligaments of the distal ankle, disrupts the connective tissue between the two lower legs bones, and causes the fibula to break near the knee. Associated avulsion fractures the lower ends of the fibula and tibia may also occur. Often the injury is reported as a high ankle sprain with a fractured fibula. The resulting damage can leave the ankle almost completely unstable and surgery maybe necessary to restore joint integrity.

The Chargers have already placed Woodhead on the injured reserve and have hinted surgery will likely be required. Expect Woodhead to consult with other physicians before going under the knife. Maisonneuve fractures and treatment have a high success rate in recovery, though the length of time to completely heal can vary from person to person. Given that Woodhead is an elite level athlete with a notoriously strong work ethic, a six-month recovery seems realistic with additional treatment carrying over into training camp.

In the meantime, Donald Brown becomes the primary option in San Diego with Ryan Mathews expected to miss at least a three more weeks recovering from a sprained MCL. Brown didn't look overly impressive rushing for just 62 yards on 31 carries. However he did haul in five passes and could have more value in PPR leagues.

Matt Cassel
Cassel suffered what is being called multiple fractures in his foot and will meet with renowned orthopedic surgeon and foot specialist Dr. Robert Anderson to determine the extent of the damage and possible treatment options. Fractures in the foot can be slow to heal, given the poor blood supply to the area, and are often easily reinjured. Cassel's meeting with Dr. Anderson is slated for Thursday but it's hard to imagine him playing any time soon. The injury opens the door for rookie Teddy Bridgewater to take the reins in Minnesota. Bridgewater's numbers were solid as he finished 12-of-20 for 150 yards with six rushing attempts for 27 yards. He's got plenty of upside and is worth a flier in most formats.

Dennis Pitta
Normally the upside of bone injuries is the body's ability to heal the fracture. Surgery may be needed to realign the bone but for the most part bone tissue often returns to its original strength when given the appropriate amount of time. Unfortunately that didn't seem to help Pitta as the Ravens tight end dislocated and fractured his right hip for the second time in less than two years. He underwent surgery Monday and his season, and potentially his career, is over.

Hip fractures can be difficult to manage because, like foot fractures, they have a limited blood supply. If the head of the femur fails to receive the proper amount of blood it can begin to degenerate in a process known as avascular necrosis. The best option at this point is a total hip replacement. A similar situation ended the career of Pro Bowl and Tecmo Bowl legend Bo Jackson. Look for Pitta to assess the situation in the coming months.

Owen Daniels becomes the tight end to own in Baltimore having developed a bit of chemistry with quarterback Joe Flacco. Daniels was targeted just once in Week 3 but was targeted 11 times for 9 receptions and two touchdowns in the first two weeks of the season.

Vincent Jackson
Tampa Bay has struggled out of the gate and Jackson has been no exception. He has just 10 catches through three games for a paltry 102 yards. A small fracture in his wrist won't help his cause though Jackson maintains he will play through the pain. The Buccaneers didn't indicate what specific bone has been fractured but his ability to practice on Monday is a good sign that it is something they believe they can manage. Feel free to utilize him but scale back your expectations until he shows some signs of life.

Ike Taylor
Taylor suffered a fractured forearm in Pittsburgh Sunday night win over Carolina. He underwent surgery to align the bones and create an environment more conducive to healing. If a proper union occurs Taylor could return in six to eight weeks. The injury won't affect most leagues but is relevant in IDP formats.

Turf Burns

Jamaal Charles:
Despite progress in rehab, the Chiefs medical team opted to provide the running back an additional week off to recover. The team has been conservative with their return to play guidelines in the past and the presence of Knile Davis may have impacted their decision. Kansas City doesn't play until Monday providing Charles an extra day to rest. However he will likely be a game-time decision, making him a dangerous play in fantasy. If you own Charles but missed out on Davis, consider utilizing a player guaranteed to play in Week 4.

T.Y. Hilton: Hilton sprained his ankle Sunday but all reports suggest it is a minor or Grade I sprain. Monitor his workload throughout the week but it looks like he will be in uniform come against the Titans.

Brandon Marshall and Alshon Jeffery: Both Bears receivers logged minutes in Week 3 despite nagging injuries. Marshall's ankle sprain looked fine in Week 2 but he aggravated the area late in the first half of Week 3 and briefly left the field. Jeffery, a bit a disappointment in Week 2, looked much more fluid on Monday. His hamstring strain will still be an area of concern for a few more weeks but it appears he's slowly moving past the injury.

Caron Palmer: Palmer's shoulder is improving but he isn't expected back for at least two more weeks. The Cardinals are off in Week 4 but Drew Stanton should be in line for at least one more start.