Alex Smith, Washington’s starting quarterback, suffered a broken tibia (shin bone) and fibula (small foreleg bone) during a Week 11 sack by the Texans. What does it mean for his future?
This was an ‘open’ fracture, where the sharp tip of the broken bone penetrated the skin. This contaminates the fracture, exposing it to the outside environment. This was obviously a season-ending injury, and Smith was quickly placed on injured reserve.
Open fractures are cleaned out and fixed emergently to remove any contamination as well as to stabilize the bone, soft tissues, and blood supply, which minimizes the risk of infection.“Tib-fib” fractures are stabilized by fixing the main (tibia) bone with a rod.
Intramedullary (inside the bone) rods have revolutionized the treatment of leg fractures, decreasing stiffness, weakness and healing problems compared to older methods of fixation.
Unfortunately, nothing’s perfect, and Smith’s contaminated fracture developed an infection. Smith has reportedly had further surgeries to further clean out the infection and remove any necrotic (dead) tissue. It was reported that Smith might require ‘partial reconstruction.’ This means that if part of the bone was removed because of infection, new bone (i.e. a bone graft) will be used to replace it and ensure healing. If the soft tissue envelope around the fracture becomes compromised, he could possibly require a graft or flap, but that seems unlikely. However, even if they do become necessary, with the top-notch medical care that Smith will no doubt receive, any graft or flap will be taken from an area and done in such a way that it will not affect his future playing career.
These additional procedures will no doubt slow down the treatment and following recovery process. For Smith, this series of surgeries could turn into a prolonged, brutal grind. And his post-surgical rehabilitation will be intense and painful.
However, ultimately, Smith is young, strong, and receiving excellent medical care. His infection is being treated seriously with continued hospitalization, antibiotics and surgeries. With this good care, his bones should heal strongly in a good position. Despite the serious nature of his problems, I expect Smith to make a full recovery and to be the starting quarterback for Washington in 2019.