What Exactly Happened?
On October 17th, Boston Celtics small forward Gordon Hayward sustained a horrific injury. While jumping for a contested ball he landed awkwardly resulting in his ankle being turned 90 degrees from its normal position. The injury was covered extensively in the media as it was the first game of the 2017-2018 season. The confirmed diagnosis was an ankle dislocation and fractured tibia. The ankle was relocated on the court and further tests were performed to determine the full extent of his injuries. Hayward underwent surgery to repair the broken bone and stabilize the ankle the following day. 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
There are three bones that make up the ankle joint. Those bones are called the fibula which sits laterally, the tibia which sits superior and medially (inside) and the talus that sits inferiorly. There are also several ligaments that help to hold the ankle joint in place. 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. One treatment option is to place the patient in a cast and progress them to a boot and gentle physical therapy at about 4 weeks, with likely return to play at approximately 3 months. The pictures below depict the normal position of the ankle.
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 Gordon Hayward, he sustained a fracture of the tibia bone. 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.
Pre-Surgery (After Relocation)
Post-Surgery
Treatment Timeline Up Until March 2018
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
Most reports estimate that Hayward's timeframe would not be until about 6 months which would put him out for the playoffs. At this point, the Celtics have stated he will not return this year and that doesn't look to be changing, especially with other injuries for the Celtics piling up. You can read more about the Kyrie Irving's chronic knee pain on a related post.