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The world responded with shock and concern after superstar golf pro Tiger Woods suffered severe multiple leg injuries after crashing in a single-car rollover accident in Southern California on Tuesday. In a statement posted to Tiger's Twitter account the next day, doctors said Tiger suffered comminuted open fractures - bones that were broken into more than two pieces and with breaks in the skin - in the upper and lower portions of the tibia and fibula of his right leg. Surgeons placed a rod into the tibia of his right leg, and they used a combination of screws and pins to stabilize injuries to his foot and ankle. Doctors said he also suffered trauma to the muscle and soft tissue of his right leg, which required surgeons to release "the covering of the muscles to relieve pressure due to swelling." We asked Orthopaedic Trauma Surgeon Rajeev Garapati, MD, NorthShore Orthopaedic & Spine Institute, to answer questions about the injuries and what recovery might involve for the elite golfer.
Q. You are not Tiger’s physician, but you are experienced in treating similar traumatic orthopaedic injuries. What was your reaction when you heard the news about Tiger’s accident?A. My first reaction was shock and wondering if he was okay because just from seeing the pictures he was obviously in a life-threatening accident. If this had occurred 20 or 30 years ago, these patients would have died from head and chest injuries. Nowadays, they survive because car safety has increased tremendously. However, you give up the legs and arms to save the head, chest and neck. Q. Medical officials familiar with Tiger’s care wrote that he suffered comminuted open fractures. What do they mean by “comminuted.”A. “Comminuted” means the bone breaks into multiple fragments instead of a simple, clean break. It’s like if you drop a plate and it breaks in two pieces, that is a simple break. Comminute means the plate shatters into multiple pieces when you drop it. It’s more of a descriptive term and doesn’t bear much on prognosis.Q. Other than car accidents, what else could cause similar injuries? A. These are higher energy injuries, such as fall from heights that roofers or tree cutters might have, falling 10 to 20 feet down. You don’t see these injuries in sports as much. Q. What does it mean that he suffered trauma to his muscle?A. He had what is called compartment syndrome. Our muscles are contained or kept in position by a covering of tissue, which is like a compartment. When there is a lot of swelling, the pressure builds in these compartments and has to be released, usually by cutting the skin and the tissue covering the muscle. If you don’t release the muscle, you can lose blood flow to it and it could die. Q. What type of surgery is typically performed for a patient who suffered similar injuries to what Tiger experienced? A. First of all, in any trauma situation, it’s about preserving life over limb. So their priorities are to make sure he doesn’t have any other Injuries. He was talking and awake so those were good signs. When you consider the leg injuries, the priorities are preventing infection, tending to the open wounds, and stabilizing the fractures. From news reports, it sounds like his doctors inserted a rod into the center of his tibia to hold everything in place and back to its proper position. They also used screws in his foot and ankle to stabilize it. Q. What will his doctors watch for over the next few weeks?A. Their first priority is to prevent infection in that area, evaluate the muscles, and get the skin, tissue and incisions to heal.
Q. How long would someone be hospitalized? A. He may need a couple more surgeries to clean up everything properly and get the fasciotomy wounds closed, so at least a week or 10 days minimum. Q. When can he put pressure, like running, walking or working out, on that leg? A. It will probably be about two to three months for the bones to heal, possibly longer. There is a risk that you can develop a non-union where the bones don’t heal or you need surgery again to get them to heal. I estimate 6 to 12 months for full rehabilitation. Q. It sounds trite to ask about his return to golf considering the traumatic experience, but do you expect these patients to return to their activities?A. He’s 45 years old, healthy, strong, has a good baseline – all of this will definitely help him. It also depends on the motivation of the patient – and we all know he is motivated. From a physician’s perspective, the obvious elephant in the room is will he play golf again, but there are so many other things that take priority, golf is the furthest thing from his physician’s mind at this point.