Brittle skin is a big problem in the return of Tiger Woods

More will be revealed about Tiger Woods’ condition in the days and weeks ahead, including his quality of life going forward, let alone the minor question of whether he will ever be able to resume his golf career in the wake of a catastrophe. rollover car accident.

Posted on Woods’ Twitter account early Wednesday was the following statement from Dr. Anish Mahajan, Medical Director and Acting Executive Director of Harbor-UCLA Medical Center, describing his condition:

“Mr. Woods suffered major orthopedic injuries to his right lower limb that were treated during emergency surgery by orthopedic trauma specialists at Harbor-UCLA Medical Center, a level 1 trauma center. Comminuted open fractures that affect both the Both upper and lower parts of the tibia and fibula bones were stabilized by inserting a rod into the tibia.

“Additional injuries to the foot and ankle bones were stabilized with a combination of screws and pins. Trauma to the muscle and soft tissues of the leg required surgical release of the muscle covering to relieve pressure due to swelling. “

A more detailed explanation of that summary was provided by Dr. Kenneth Jung, an orthopedic foot and ankle surgeon. Although Jung is not involved in Woods’ treatment, he spoke in general terms about the type of injuries described, which commonly occur in high-energy car accidents.

That the injuries occurred to Woods’ lower right leg is not surprising, Jung said, because they usually occur when a driver squeezes the brakes, as opposed to the left leg, which could be to the side. The demolished front end of the truck Woods was driving appeared compressed and sagged from the accident.

The tibia and fibula are the two bones in the lower leg, and a comminuted fracture refers to a bone that is broken into multiple fragments, rather than a clean fracture.

The term “open” means that the bone passed through the skin and was exposed to the outside world. That greatly increases the risk of infection, as happened to Washington Football Team quarterback Alex Smith, who suffered a horrific broken leg that, after subsequent infections, brought the risk of amputation and put his life in danger.

“A lot of people focus on bone injuries, but that’s only part of the story,” said Jung of the Kerlan-Jobe Institute in Los Angeles. “The soft tissue wrap, or the skin, is also very important. If you don’t have skin covering the bone, it doesn’t really matter how the bone looks or heals. “

With Woods, or anyone who suffers an open fracture, these first few days after an accident are critical in charting the way forward.

“It’s usually pretty routine in the first 24 to 48 hours to take someone back to the operating room to wash the tissue, wash the wounds again, re-inspect the tissue for necrosis or death,” he said. Jung.

The tibia is the shin bone that you can feel under the skin. If wounds are having trouble healing, doctors can use skin grafts or transfer muscles from other parts of the body to cover that bone.

In his statement on Woods, Mahajan described trauma to the muscle and soft tissue of the leg that required “surgical release” of the fascia covering the muscles. This surgery is done to release pressure that results from swelling after trauma.

“I tell patients that their muscles are basically in these compartments, almost like hot dogs,” Jung said. Imagine boiling a sausage and the meat begins to expand. When you make a cut in the sausage casing, the meat swells up. That’s similar to what they’re doing with those compartment releasers. “

A law enforcement officer looks over a damaged vehicle after a rollover accident involving golfer Tiger Woods

A law enforcement officer checks the damaged vehicle. The impact to the front of the car often leads to lower leg injuries when the driver has depressed the brake pedal.

(Ringo HW Chiu / Associated Press)

Jung said that compartment syndrome can occur almost immediately and produces uncontrollable pain.

A combination of screws and pins was used to stabilize Woods’ ankle and foot bones. While screws are typically used to fix fractured bones, pins are often used to stabilize joints that may have dislocated.

Jung said that a common concern is an injury to the Lisfranc joint complex in the middle of the foot, again common in car accidents when a driver is pressing the brake pedal at the moment of impact.

“Those injuries have a high association with post-traumatic arthritis,” he said. “That would generate concern in my mind not only with golf but with the future in life. That would manifest as pain and stiffness in the foot joints. “

Jung said that even for doctors working at Woods, it is too premature to predict an outcome. At the moment, much depends on the skin and avoiding infections.

“You can have your bones more perfectly aligned, certain orthopedic surgeons have done the best job in the world to align everything,” he said. “But if he did develop an infection unfortunately, all of that would be put in jeopardy.”

The road to recovery is likely to be long. The first few days after this type of injury generally require antibiotic treatment and monitoring for infections and blood flow, according to Dr. Gregory Tennant, an orthopedic surgeon at Kaiser Permanente Medical Center in Fontana.

In the following six to nine months, the focus is likely to be on bone and wound healing, followed by a recovery phase of physical therapy and rehabilitation.

“My expectation would be that I wouldn’t anticipate it while walking for a while,” Tennant said.

Although most of the injuries Woods’ doctors describe are to the lower extremities, the golfer had recently undergone his fifth back surgery. The accident may affect your recovery from that.

“Trauma is never really an isolated event,” Tennant said. “It is not uncommon to identify injuries, even significant injuries, days later when initial high-energy injuries are treated.”

Ultimately, however, Tennant said Woods is in excellent hands at Harbor-UCLA, which handles these types of injuries all the time, and is optimistic about the legendary golfer’s recovery.

“Tiger Woods has been a winner all his life,” he said, “and one thing I’ve learned is that you don’t bet against winners. You don’t bet against Michael Jordan. You don’t bet against Tiger Woods. “

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