Dr. Jeffrey E. Budoff is a board-certified orthopedic surgeon who wades through misleading coach-speak and vague team injury information to offer advice for your fantasy team. Here’s the Week 16 injury update.
On Sunday, DerMarco Murray fractured (broke) his left 4th metacarpal. That’s the long bone in the body of the hand that supports the ring finger. On Monday he underwent surgical fixation using a plate and 8 screws. The obvious fantasy football question is whether or not Murray will play Sunday.
First, some information about the fracture. In non-smokers, metacarpal fractures usually take three weeks to heal, six weeks to heal strongly. So there’s risk with returning early than three weeks. Having said that, at two weeks the fracture is often ‘clinically healed’, meaning that it’s no longer very tender or swollen, and has minimal pain with stress. Emmitt Smith underwent surgery for a metacarpal fracture, took a week off, then played two weeks after surgery in a protective splint. I think that’s reasonable.
Fast forward to 2014. Murray was back practicing Wednesday, two days after surgery, in a limited basis. He was catching passes using mainly his right hand. He underwent a limited practiced again on Thursday. It looks to me like the Cowboys are willing to risk their star running back’s health by playing him on Sunday. Remember, this is the same franchise that put Tony Romo back into the Redskins game Week 8 after he injured his back. Brandon Weeden was playing well, but they nonetheless risked Romo in a situation where he wouldn’t be able to move well and avoid pressure, exposing him to further injury. The Cowboys may currently believe that they’re playing for their playoff life, and are willing to risk it all to beat Indianapolis this week.
Earlier this week, Jerry Jones was quoted as saying, “It’s probably a tough expectation to think that he (Murray) can (play), but we’ll see. I agree with that. I also read a report saying that Murray ‘can’t do any more damage by playing through it'”. To which I reply: ROTFLMAO.
Look: sometimes you gamble and you win. If nobody ever won gambling, Las Vegas would never have become so popular. On the other hand, the Redskins gambled with Robert Griffin’s health during the 2012 playoffs against Seattle. He hasn’t looked the same since. The 2013 Patriots gambled by bringing Rob Gronkowski back 5 weeks after surgical fixation of a forearm bone. Too early IMHO. Not surprisingly, he refractured his forearm, underwent revision plate fixation, developed an infection, then needed several more surgeries to cure the infection and get the forearm to heal.
In surgery we have a saying: Complications beget complications. What that means is that you want things to go right the first time. You maximize the chances of things going right by 1) Getting an experienced sub-specialist (hand surgeon, shoulder surgeon, not just a general orthopedist) to do your surgery. 2) Not messing it up afterwards. This means letting it heal. If you rebreak it, or don’t allow it to heal properly, and a second surgery is required, this greatly increases the chance of a third surgery being required. And maybe a fourth, etc. You get the idea.
Requirements for plate and screw fixation of a metacarpal fracture are 4 screws. Murray got 8, double what is required. This provides very strong fixation. I’ve never seen Murray’s X-rays, but I’m sure that his hand surgeon used locking screw fixation. Locking screws are extremely strong. They not only go through the plate into the bone, they have small threads near the screw head that lock into threads in the plate. Even a single locking screw on either side of a fracture increases the rigidity of the bone-plate construct by a factor of 5. Why did his surgeons provide twice the required fixation for his hand fracture? Probably not because they thought he was going to rest it for the next 3 weeks. They’re preparing him to play Sunday.
Evaluating the research
I read an article by an injury analyst that quotes a study presented to the American Orthopedic Society for Sports Medicine (AOSSM) earlier this year. This study reported an average of 2.8 days missed by elite football players following surgical fixation of simple metacarpal fractures without any re-fractures or other complications. This study included all positions, including those that don’t handle the ball and could play in a cast. The analyst also noted that both Julio Jones and Eddie Lacy played in college in under a week following this surgery.
While the latter two cases may be true, having spent a decade in academics and having served on multiple meeting committees that invite papers to be presented and also having edited for multiple journals, including the Journal of Bone and Joint Surgery and the Journal of Hand Surgery, I would caution analysts to be wary of quoting papers that have been presented but not published. When papers are invited for presentation, they’re chosen based on a paragraph or two that interests the committee enough to want to hear the author speak about his research for 5-10 minutes. That doesn’t mean that what is presented is accurate. In fact, roughly 50 percent of research papers that are presented never get published. The reason is that in order to publish research in a reputable journal it needs to go through an extensive, highly formalized peer review process, where experts in the field ensure the accuracy of the research, and make sure that the conclusions of the authors are supported by their data. It is only once the paper is published in a reputable peer-reviewed medical journal that it should be considered reliable data.
But I digress. Getting back to fantasy football: what I’ve read combined with the history of the Cowboy’s organization leads me to believe that they plan on playing Murray this Sunday.1 As someone with Murray on one of my fantasy teams in the finals, if he plays should I leave him in my starting lineup? He’s carried that fantasy team this far. Obviously, it depends on my other options at running back, but if I start Murray what should I expect?
One concern is Murray’s ability to grip the football. It’s been noted that Murray prefers to carry the football in his right, uninjured hand. However, running to the left that would expose the football to the defense, increasing his risk of fumbling. And he’s already fumbled a few times this year. A lack of grip strength in his left hand will further increase that risk. His ability to catch will be limited, so Dunbar may relieve him on passing downs. Especially because trying to block a blitzing linebacker with that hand would be foolhardy.
He’ll probably require a pain-killing injection about the bone to be able to handle the impacts of being tackled, hit and falling. I’m sure that the Indianapolis defense is aware of his injury, and his left side now becomes a target. No matter what type of splint he wears (he’s currently in a ‘hard plastic shell’), it’s not going to shield him from the pain of helmets, shoulder pads and the ground repeatedly hitting that hand. Even with the injection, he might have to leave the game if things get too rough. Not good if you’re counting on him for fantasy point production.
A brief foray into Murray’s extensive injury history will quickly reveal why many consider him injury prone. While he’s been healthy this year, playing with an injured hand will compromise his ability to protect himself from defenders. He won’t be able to stiff arm well or to fend off tacklers, allowing them to get into his body, increasing the risk of other injuries. You know the old story: when you consciously try to protect one part of your body, you leave other parts exposed and vulnerable.
If he does re-fracture his hand he’s looking at repeat surgery and probably IR, ending his season. Refractures, especially with a plate in place, are almost always worse than the original fracture. Usually much worse. If this happened, even if the Cowboys won this game and made the playoffs, without Murray I don’t like their chances in the post-season at all.
If I were Murray I’d take a week off, and return for Week 17 with two weeks of healing and a fracture that was either clinically healed or very close to it. This is a much safer course. But Murray and the Cowboys have never asked me for my opinion, so don’t be surprised if you see him take the field this week.
BTW: For further information on hand fractures, and to watch a video of surgical fixation of a metacarpal bone please go to http://www.rearmyourselftexas.com/hand/finger-fractures/
- For comparison, note how conservative the Packers were bringing Aaron Rodgers back from a clavicle fracture last year (back)