Sports
AS Tiger Woods begins his long road to recovery following the car accident that smashed his lower right leg, there are many questions over the future of the American golfing superstar.
Woods received emergency surgery involving the insertion of a rod to support multiple open fractures in his right tibia and fibula. Pins and screws have been applied to support the ankle and foot on the same leg.
No one knows whether the 45-year-old winner of 15 major titles will be able to compete again at the highest level and only those closest to his treatment have any knowledge of how the coming weeks and months of his recovery might develop.
But with the limited details that have been published, experts are able to outline likely scenarios. As a former PGA Tour player, Bill Mallon is well placed to offer informed opinion having studied at medical school at Duke University and qualifying as an orthopaedic surgeon.
Mallon has worked in emergency rooms dealing with surgeries that have followed car crashes similar to the one Woods endured last Tuesday. Now based in Hilton Head, South Carolina, Mallon is editor-in-chief of the Journal of Shoulder Elbow Surgery.
We asked Bill 10 key questions.
- How serious are his injuries?
It is serious for certain, but I’m not sure I can put a numerical value on it. These are things that you see all the time in orthopaedics. It is not an uncommon injury by any means. It’s not like nobody has ever recovered from this, indeed, most people do recover.
A right leg injury is typical for a car accident because you put your right foot on the pedal for the brake and it stabilises against that. When you have an impact from the front it drives the front part of the car into your leg and compresses it.
The American Football player, Alex Smith, sustained a similar injury to his tibia, an open comminuted fracture (a break in more than two places) in 2018 and he developed all sorts of complications. He almost lost his leg and ended up having 17 surgeries. I think because that is fresh in the minds of the American sports public they are extrapolating that to Tiger and assuming he’s going to go through the same thing.
That’s not necessarily true and in fact Alex Smith is the exception. The normal situation is that you heal, you don’t get an infection and you are able to walk again.
- How important was it that Tiger was operated on so quickly after the accident?
It is very important to decrease the risk of infection in the leg. If any dirt gets in the wound or there’s any contamination, it needs to be cleaned out as quickly as possible.
There was also the possibility of compartment syndrome, which is increased pressure on the muscles, nerves and arteries which can cut off the blood supply to the lower leg. It was very important to get that treated as quickly as possible so that blood supply is not cut off and you get dead muscle and dead tissue in the lower leg.
- Will he be in great pain and is how that is managed a concern?
Tiger has a little history of drug problems after a couple of his back surgeries. These will certainly be painful injuries and normally we would give patients painkillers to manage. Tiger will have to be careful with how much of that he uses and the doctors will know about that and be careful too.
We are much more cognisant in the US now because of what’s been going on in the last few years with the opioid crisis. We realise a lot of people have overdone usage of that, but Tiger’s past history does mean he will need to be monitored a little closer.
- How vital is this post surgery period?
They will be looking out for how well things are functioning in Tiger’s leg and checking the blood supply. The dressing of his wounds may be being changed or they’ll wait a couple of days depending on the surgeon’s preference.
In the hospital they will be checking his vital signs to make sure there is no fever or anything to suggest a developing infection. They’ll check this blood count too because it is a big surgery and he could have lost some blood.
- What will his treatment programme be?
It is hard to say without seeing the fractures and the X-rays but, most likely, he will be put on some sort of protected weight-bearing status. He cannot bear full weight. In orthopaedics we have degrees of weight-bearing status.
I can’t say what degree he will be on but he will be protected either with a walker or most likely a little rolling walker where you put your bent knee on the walker and kind of walk on your left leg and roll along on the right.
Ideally you want to be weight bearing on the shin now that a rod has been inserted but that process is more difficult because of the multiple fractures in his ankle and foot. It is a little bit of a worry but we deal with these issues. It’s not something we have not dealt with before.
- Is his age a factor?
In golf terms people talk about him being 45 and he’s kind of past his prime, but orthopedically we’d say he was still fairly young. It’s still a good time to heal things at 45.
- How quickly could he heal?
Most fractures heal fairly well in six weeks to three months. In the lower extremity it is usually three months or so. I don’t know how much soft tissue damage there is. The more there is interrupts the blood supply and everything heals with blood supply so that could delay the healing a little bit.
I still think in three to four months he may be able to get full weight bearing status on that leg. The good thing Tiger has going for him is that he’s always been in excellent health. He’s worked out, his muscles are strong so he’s going to have intrinsically fairly good blood supply to that leg.
The problem is we don’t know how much of that has been interrupted by soft tissue injury.
- Does the fact he’s recovering from back surgery complicate matters?
I don’t think so in terms of his leg healing. But the leg problem may complicate matters for his back. He may not be able to do some of the back rehab that he was doing. It is possible that he sustained some trauma, probably minor, to the back as well which Tiger does not need given his history.
- What are his chances of playing again?
Assuming that Tiger’s leg heals without an infection, the next problem is the other fractures he has in his foot and ankle. They may cause him arthritis down the road. But even if he gets that, I think he will walk again and I think he could probably play golf again.
He may be able to play competitive golf again as well, but he’s a year out from that – he’s not going to play this year, I don’t imagine.
- Does the fact that it is his right ankle make it more beneficial for golf?
Yes, for a right-handed player your left ankle would be under much higher strain because that’s the leg that is twisting and turning as you come down into impact at high speed.
The right leg is under more stress on the backswing but that’s much less stress than the left leg feels during the downswing and impact.
BBC Sport
Feb. 26, 2021 @ 8:39 GMT
Tags: recovery and return of former world number one Tiger Woods car crash: 10 questions on injuries
