What Exactly Happened?
Updated Post 10/11/2020 - 1900
Today, October 11th, Dak Prescott QB sustained a horrific injury. While being tackled his ankle twisted awkwardly resulting in his ankle being turned 90 degrees from its normal position. The injury is reminiscent of Delanie Walker of the Tennesse Titans and Tyler Eifert last year. The likely diagnosis at this point is an ankle dislocation and fracture (confirmed). The ankle will be relocated and further tests will be performed to determine the full extent of his injuries. Additional information describes that Prescott's injury is complicated by being an open fracture meaning the bone broke through the skin. Prescott is reportedly undergoing surgery to clean the would and possibly repair the broken bone to stabilize the ankle. This blog post is going to take a step-by-step approach to understanding the injury, surgery and recovery. Let's start with the ankle dislocation.
Ankle Dislocation
When an ankle dislocation occurs, the talus comes out from under the tibia to sit outside of the true ankle joint. It is possible for this to occur without a fracture, but this is usually not the case. When the ankle dislocates the ligaments by default are torn. If a patient has a simple ankle dislocation, with no fracture the patient can be treated with cast immobilization to allow the ankle to heal. However, this is clearly not the case in Prescott's situation.
Ankle Fracture & Dislocation
When the talus is forcibly pushed out of the ankle joint it can cause the surrounding bones of the fibula and tibia to become broken. In the case of Prescott, it is not clear if he sustained a fracture of the tibia, fibula or both. Remember, this would be in addition to the supporting ligaments that are by default torn during the dislocation process. An MRI would be helpful to determine the extent of ligament damage as well as if any cartilage damage has occurred. When the tibia or fibula is broken, the surgical repair usually involves a screw fixation to stabilize the fractures. Gordon Hayward likely underwent a similar fixation to the tibia bone as well as ligament stabilization procedure. The picture below shows both a fracture of the tibia and fibula that can occur with an ankle dislocation. You will also see how the screw fixation is performed to stabilize the fracture. The pictures below don't show the exact mechanism that likely occurred with Prescott but is a general depiction of an ankle fracture-dislocation.
Pre-Surgery (After Reduction)
Post-Surgery
Treatment Timeline
Based on Gordon Hayward's timeline here how things should go for Walker. On October 18th Gordon Hayward underwent surgery to stabilize his ankle and fix his fractured tibia. It appears he was placed on a non-weight-bearing status, which is why he was using a scooter initially. Approximately one month later, he was transitioned to a walking boot and placed on crutches. About 3-4 weeks later in early December (2 months post-op) he was transitioned from the walking boot to an ankle brace and cleared for full walking. 3 months postoperatively he was seen shooting set shots so likely cleared to light activity. At 5 months the intensity of his training has progressed to the point of dribbling and shooting, therefore he is most likely cleared to agility drills and non-contact activity. Keep in mind he should be doing cross-training, conditioning and upper body lifting throughout the recovery process.
Return to Play
My estimate is that Dak Prescott timeframe would not be until about 6 months which would put him out for the season. At this point, it is all but certain he will not return this year and that doesn't look to be changing, but he will be back.