Tyler Lockett

[hburn21]

Lockett had surgery already for both a broken fibula and tibula. Carroll said he should be up and moving in 4 weeks.

 

[bigskydoc]

About 3AM I was awake, with my mind wandering again, and I thought "given the paucity of info we are likely to get, and the fact that I keep saying that complications could result in a longer recovery time, what kind of info might be released that would be an indication that there have been complications?"

Infection is the absolute biggest risk here. Infection could be career ending as it can impair the ability of the bone to heal properly. We can expect Tyler to have anywhere from 1 to 2 surgeries this week (including the one he would have had Saturday night). Sometimes we will do an immediate washout, followed by a delayed intramedullary nailing in a second surgery. Sometimes we do both in the initial surgery. If Pete happens to mentions that Tyler required another surgery anytime after mid-week, we can be concerned that he may have an infection or compartment syndrome.

Compartment syndrome - a rare, but serious, complication of tibial fracture. The muscles of the lower leg are encased in tough, fibrous compartments of tissue. If the muscles swell, the pressure in these compartments can get high enough to choke off the blood supply to the muscles resulting in potentially irreversible muscle injury. If this complication is recognized promptly, an emergent return to the OR, for fasciotomy, can save the leg. If recognition is delayed, this is a devastating and probably career ending complication. If Pete says something about going back to the OR for some swelling, we can worry about this. Given his status with the Hawks, we can expect they will be watching for this like, well, a Hawk.

Non-union. There is always the possibility that the damage is severe enough that the bone has difficulty healing properly. This is more common with a comminuted fracture where there are a bunch of little bone fragments that have to organize back together again. It is possible that Tyler suffered this type of fracture. Modern nails are amazing though, and will give Tyler a really good chance of healing properly even if he has a really bad break. Likely Pete won't be giving us any clue as to the extent of the fracture, but if, in 2-3 months, he happens to say something about Lockett not healing up right, we can start worrying about this.

Nerve damage. Nerves are extremely tough, but can be cut by sharp bone ends. A cut nerve will never be the same. Prompt reconnection may give some of the function back, but the recovery is protracted. Likely career ending. If Pete says anything about nerve damage and a longer recovery, we can start worrying about this. However, there can be minor, typically temporary, nerve injury from the initial injury, or during tibial nailing. This could drag out his recovery for a few months. It may be tough to tease out what kind of nerve injury Pete might be talking about. If he gives a timetable within a year, then it's a good bet we are talking about the latter.

Ligamentous injury. Isolated bone injuries are possible, but commonly there is ligamentous damage above and below the break. This will be the toughest to tease out, unless someone who knows something comes right out and says it. A subsequent surgery in a few weeks to a few months would be suggestive of a ligamentous injury.

One thing to keep in mind that we shouldn't really worry about is that he may have a subsequent operation to remove the screws in a few months, or the intramedullary nail in a year or so. Depending on the type of nail placed, they may plan to remove the screws in about three months. If placed in adulthood, these nails can stay in forever. Sometimes they are removed because they are causing pain. I haven't treated any professional athletes with a tibial nail, but it is possible that he won't feel "right" with the nail in. While it closely mimics the flex of natural bone, it isn't perfect, and a professional athlete may be more sensitive to this difference than your average weekend warrior or couch potato.


Disclaimer: I'm an anesthesiologist, not an orthopedic surgeon, so my understanding is far from perfect, and my information on nails may be somewhat dated at this point.

 

[Yoonhawk]

Thanks for the info, Bigskydoc. Came to the site just for this.

 

[Tbone]

BigSkydoc thank you for the knowledge on this topic. It's unfortunate that we may not hear much from the organization regarding the topics that you mentioned but was good knowing all the potenial setbacks.

 

[Yoonhawk]

Carroll indicated that there is no ligament damage.

 

[bigskydoc]

Thanks. I typed that up before I had a chance to listen to Pete Carroll's conference today.

My thoughts on his statements or responses to statements.

"Just the break, not ligament stuff like Rawls had." This is the big, awesome news. As Pete says, this puts him on track to be back (reasonably fully) for training camp.

"Lockett is staying in the hospital for another day or so because it's easier for him." It could be that Lockett doesn't have much help at home and it is better, from a assistance standpoint, for him to be in the hospital where he has help. Also possible, they are wanting to keep a close eye on him for signs of infection or compartment syndrome. I'm 50/50 on which.

"He has a chance to be up and moving 4-6 weeks from now." Lockett is already up and moving although he may be restricted from even letting his foot rest on the ground for another day or two. Usually we don't allow our patients to bear full weight on their rodded tibias immediately, but they can rest their foot on the ground. I suspect he means that Lockett will be walking on it in 4-6 weeks. This is reasonable for a typical tibial rodding.

"All indications he will have a chance to come back. There is always the opportunity for complications" Pretty much what I have been saying.

"Compound, displaced fracture" Just confirms what we suspected.


All in all good, reassuring news that is in line with what I expected

 

[Seahwkgal]

Lockett's injury just breaks my heart. Such a sad end to the season. Wow. I am glad I didn't get to see the game or that play. I probably would have been in tears. Poor kid.

 

[Hawks46]

A healed bone isn't going to effect his speed. Associated ligament injury might.

His build had nothing to do with the injury. Any leg, subjected to that kind of impact, is going to break.

Beat me to it. You're obviously more knowledgeable than I am on this, but I've screwed myself up enough (and paid attention)...evidently like a few of us here on .net.

That said, where the break was...any chance of a ruptured tendon in that spot ?

 

[potatohead]

A question I have is... If Tyler comes back and is ready say, mid next season, is he actually going to be playing with a rod/screws/nail in his leg? Or would it be removed first?

 

[bigskydoc]

Barring any complication, it won't be mid-season. He will be ready to go at training camp. Unlikely 100%, and likely not full contact, but should be able to fully participate in drills. He should be at his new 100% by the first game of the season.

 

[Hawks46]

Barring any complication, it won't be mid-season. He will be ready to go at training camp. Unlikely 100%, and likely not full contact, but should be able to fully participate in drills. He should be at his new 100% by the first game of the season.

Thanks for all the updates. Good news for Lockett. I remember when I tore my ACL thinking I wished I had broken my leg instead. It's starting to look like Lockett is going to be ok with no ligament or tendon damage.

 

[grizbob]

He's on social media with his update.

https://www.facebook.com/Seahawks/video ... 940831722/

 

[GeekHawk]

A question I have is... If Tyler comes back and is ready say, mid next season, is he actually going to be playing with a rod/screws/nail in his leg? Or would it be removed first?

They'll leave them in unless there's a reason to take them out. When I got a plate in my wrist in 1986 it stayed in until it started irritating my finger-muscle tendons that attach to my forearm muscles. When I got my leg/foot reconstructive surgeries after the Big Wreck they took out the screw that was attaching the fibula to the tibia (acting as a spacer until the bottom half of the fibula turned back into bone from mush) and they took out the screw that was attaching the pieces of the bone graft together in my calcaneous, and also holding it in position relative to the talus (the big round bone that the tibia, fibula, calcaneous, etc attach to in order to form a working ankle). They left the plates and screws on both the tibia and fibula. Been there since 2004 (tib) and 2005 (fib).

 

[IndyHawk]

Geek I understand now why my mom said she would kill me if I got a Bike..I hope your done riding because that is just brutal..Glad you lived

 

[bigskydoc]

That said, where the break was...any chance of a ruptured tendon in that spot ?

It's not so much where the break is, as it is how the break happened (the mechanism of injury). Ligament injuries tend to happen when the foot is planted and the ligaments become the part of the system with the most give. Earl Thomas and Tyler Lockett both were spared significant ligament damage because their feet were not planted when they suffered their injuries. When I saw Lockett's foot flopping around while the leg was breaking, I was reassured that he would have a straightforward break, and likely not a ligament injury.

That's not to say it's impossible to have ligament injury with these mechanisms, just that it is much less likely for there to be significant injury than when the foot is planted.

is he actually going to be playing with a rod/screws/nail in his leg? Or would it be removed first?

It depends on the type of repair done and the nail that was used. Typically we repair these with a dynamic nail that mimics the natural flex of bone. The center of the bone is reamed and the nail is inserted into that channel. Screws are placed through the bone and into the nail at both ends. This holds the nail in place and helps keep the bone ends aligned correctly while they heal.

With this type of repair, it is possible to leave the entire apparatus (screws and nail) in place long term. However, it is possible that an elite athlete may notice that the flex is not perfect and will elect to have the entire thing removed. We have patients who get them removed due to pain or other reasons.

Older nails were static and the screws had to be removed before fully loading the leg. We are getting to the border of my orthopedic knowledge here, but it seems theoretically possible that a bad break, with multiple small fragments, might heal better with a static nail. From my, once again, theoretical knowledge of bone healing, I suspect that a bone would heal better with a very slight amount of movement, as opposed to being firmly fixed. So they may not use static nails anymore at all. I'm just not sure.

 

[brimsalabim]

I'm sorry for him and prayers for his recovery but note to JS and co. Quit drafting tiny receivers and athletic offensive tackles. Neither blue print is working out for us.

 

[bigskydoc]

DezBryantAnquanBoldinAlshonJefferyJulioJones would have suffered the exact same injury as Lockett.

Being 6' 7" 265 lb didn't protect Graham from an injury similar to P Rich

 

[Seanhawk]

I'm sorry for him and prayers for his recovery but note to JS and co. Quit drafting tiny receivers and athletic offensive tackles. Neither blue print is working out for us.

Yeah, let's try picking up some unathletic offensive tackles. We'll really take off offensively.