What Happened to Anderson Silva’s Leg? Tib-Fib Fractures Explained.

For those of you who don’t know, I’m a huge UFC fan, a practitioner of Brazilian jiu jitsu, and a former (amateur) practitioner of muay Thai. So it should come as no surprise that I’m devoting today’s posting to Anderson Silva’s horrific injury that was suffered during the former champion’s (for six years!) rematch against the man who took his title, Chris Weidman. Everyone who was watching the fight was shocked when Silva broke his leg in half against Weidman’s knee while throwing a leg kick. And let’s start there. A lot of folk’s think that it was an accident that Weidman’s knee happened to contact the former champ’s leg; in other words, that Weidman “got lucky.” He didn’t. The knee block that Weidman skillfully threw is called a “kow bang” and it is one of the most difficult techniques to execute in all of muay Thai, so difficult that I couldn’t even find an uncopyrighted image to show you, having to settle for the similar, but less difficult to execute, elbow block instead.

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An elbow check. The usual way to block a high Thai kick is to catch it with both of your forearms (one is no good because it will likely break). The elbow block is substantially stronger than the forearm block, potentially damaging your opponent’s shin at the same time that it protects your noggin. The problem is that this block is much more difficult to execute than a traditional, forearm block and that missing the block means catching the full impact of the kick with your head!

The kow bang is intended to cause microfractures and pain in your opponent’s tibia (shin bone) so that they won’t be able to continue landing Thai kicks on your legs — the technique just happened to work a little better than expected in this particular fight. The kow bang requires absolutely perfect timing to execute in the ring and the problems with missing an attempted kow bang are two-fold. The first problem is that it is easy to raise your knee too high, resulting in your opponent’s kick slamming full force into your opposite leg, the one that 100% of your bodyweight is resting on. This usually results in a spill hard onto the floor, which in mixed martial arts is rapidly followed by your opponent pounding your face in. The second issue with the kow bang is the opposite problem. If you don’t raise your knee high enough to block the kick then the kick slams right across your thigh, exactly where your don’t want to be taking Thai kicks if you’re planning to make it out of the first round walking instead of limping.

Okay, so that’s what happened in the fight. Now let’s talk about what happened to Silva’s leg from a medical perspective. Let’s first step back for a second and review the basics. The lower extremity (the calf is technically “the leg”) is composed of three major bones and a bunch of smaller ones in the foot (the patella, or knee cap, is really part of a ligament). The femur is the thigh bone and it articulates (meets) the tibia at the knee joint. The tibia is the major weight bearing bone of the leg/calf and it is the bone that you feel when you rub your fingers down your shin. This is also the bone that Thai boxers and UFC fighters use to land most of their kicks, and it is a very strong bone once it has been conditioned by years of training. The fibula is the smaller bone that runs parallel to the tibia and that at its distal (farthest from your body) termination forms that lateral (away from the midline of your body) portion of your ankle joint. The tibia forms the medial (closest to midline) portion of the ankle joint and the parts of these bones at the ankle are referred to as malleoli. Good ahead, reach down to your ankle and feel them!

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A tibia-fibula (“tib-fib”) fracture, similar to the one that Silva suffered last Saturday.

Silva fractured (fracture = break = fracture) his tibia and his fibula above the ankle joint. Fortunately his fracture was simple, which means that the broken pieces of bone didn’t pierce the skin, a really big deal because compound (open) fractures are much more likely to develop terrible infections, especially if you suffer the fracture in a blood splattered MMA ring. What Silva’s doctor did (see below for the link to his press release) was an open reduction, internal fixation to repair the fractured tibia. He then left the fibula to essentially heal on its own, which is okay because the fibula isn’t a weight bearing bone and it’s biggest contribution to the function of the leg is in stabilizing the ankle joint. In fact, orthopedic (bone) surgeons often harvest the shaft of the fibula when they need to replace a more critical piece of bone somewhere else in the body — the forearm, for instance — and the body usually does pretty well as long as the most distal part, the lateral malleolus of the ankle, is left in place.

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A compound (open) tib-fib fracture. Not good.

Open reduction, internal fixation (ORIF) is a surgical procedure during which a broken bone is loosely approximated (put back into place) in the operating room and then a rod is hammered (literally) into the hollow internal cavity of the bone to hold the healing parts of the bone in place. Recall that the insides of bone are filled with a soft marrow. This marrow is fairly easy to suction out, leaving a nice round cavity to shove a sterile metal rod to support the healing bone! The bone fragments and the rod are held together by surgical screws, which are power-drilled into place in the operating room (using a sterile drill), and after 6-9 months the bone usually heals nicely. The rod is left in place, in case you were wondering.

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Status-post open reduction, internal fixation!

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis. Amazon Link to Doc’s Writing:  http://www.amazon.com/Leonardo-Noto/e/B00ATVOMCW/ref=ntt_dp_epwbk_0

NOTE: The Life of a Colonial Fugitive — my dark historical thriller — is free for your ereader at http://www.smashwords.com/books/view/215272. Thanks for reading!

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 16-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.com is intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!

The opinions voiced on this medical blog are solely the author’s own and they do not reflect the opinions or values of Dr. Noto’s employers, past or present. Dr. Noto’s medical blogs should never be used as supporting evidence for legal testimony — this is of course obvious to anyone who isn’t a complete moron, but some people are rather stupid.

RESOURCES

Muay Thai Image. Courtesy of Wikipedia. http://en.wikipedia.org

Tib-Fib Fracture Films. Courtesy of Wikipedia. http://en.wikipedia.org

Compound Tib-Fib, Courtesy of Wikipedia. http://en.wikipedia.org/wiki/File:Offene_Luxation.jpg

ORIF Films. Courtesy of The University of California at San Francisco School of Medicine. http://www.google.com/imgres?imgurl=&imgrefurl=http%3A%2F%2Fsfghed.ucsf.edu%2FEducation%2FClinicImages%2Flower_extremity_films.htm&h=0&w=0&sz=1&tbnid=I-9_eWuyLrMYlM&tbnh=259&tbnw=194&zoom=1&docid=DXUd9umkQuW6wM&hl=en&ei=yozCUqbXJcrXyAHfzoG4DA&ved=0CAIQsCUoAA

The UFC Orthopedic Surgeon’s Press Release. http://www.lasvegassun.com/news/2013/dec/30/anderson-silvas-doctor-details-surgery-and-recover/

Malpractice 101 — What is Malpractice?

Unless you’ve been living under a rock, perhaps a rock on the surface of the moon, it will come as no surprise that heart disease is the #1 killer of Americans and that cancer runs a close second. What probably will surprise you is that the #3 leading cause of death in The United States of America is medical negligence. That’s right! You’re more likely to die of medical negligence than from a motor vehicle accident, a gunshot wound, or even pneumonia. In fact, 200,000 Americans die from medical negligence every year!

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Physicians would prefer not to think of themselves like this. Unfortunately, medicine is a difficult business and “to err is human…”

Medical negligence occurs when a healthcare provider doesn’t follow “standard of care.” Standard of care is doing what a reasonable healthcare provider (a doctor, nurse, etc.) would do in a similar circumstance. For instance, it is standard of care to listen to a patient’s lungs, get a chest X-ray, and start antibiotics for a patient with suspected pneumonia. It is not standard of care to prescribe magic mojo mushrooms for a patient with pneumonia and doing so would be negligent. Generally speaking, healthcare providers don’t go to jail for being medically negligent. Instead, American society handles allegations of medical negligence in the civil justice system (as opposed to the criminal justice system). This is the notorious, awful, infamous, horrible, terrible process known as “malpractice.”

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Bloodletting. Standard of care…in 1800.

What is malpractice? Every doctor’s nightmare! Yes, that’s one good answer, at least from my point-of-view, but it’s not the answer that we’re looking for today. The legal definition of malpractice requires four “necessary conditions:” 1. A Duty to Treat, 2. A Breach of the Duty (aka: Negligence), 3. A Harm that was Caused by the Negligence, and 4. Causation. If all four of these legal conditions aren’t met, and no matter how much your doctor screwed up, it isn’t malpractice. Let’s take the example of Dr. “X” as an example to make sense of this legal mumbo jumbo.

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The honorable esquire, John Edwards. A highly successful malpractice attorney, Mr. Edwards is also famous for his nearly successful run for President of The United States in 2004 (he ran again in 2008). He is infamous for cheating on his terminally ill wife and for allegedly paying his mistress to keep quiet about her pregnancy with his child.

A Duty: You can only sue Dr. X for malpractice if Dr. X has personally been your doctor in the past. It doesn’t matter how terrible Dr. X looks when he’s selling “Magic Health-for-Life” pills on latenite television; if you haven’t personally been a patient of Dr. X’s in the past then you can’t sue him for malpractice.

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A bad doctor, but not one that you can necessarily sue.

A Breach of Duty (i.e. A Negligence): Once we’ve established that Dr. X was your physician at some point in the past (nice work with the doc-shopping by the way!), your next step in suing him for all he is worth is to prove that he was negligent in his treatment. For example, if you showed up to Dr. X’s clinic with an ingrown toenail and he decided to do a minor surgery on your hand instead of on your foot you might just have a case.

Think Fast: What is a “Breech?”

 

________________________________________________________________________

 

Answer:

 

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A baby who is being born “butt” (or leg) rather than head first. Most breech presentations are born via C-section today due to their higher rate of birth complications.

A Harm and A Causation: We’ve now established that Dr. X was your physician (a duty) and that he was negligent when he operated on your hand instead of removing your ingrown toenail. The final necessary conditions to complete your malpractice claim are to prove that Dr. X’s negligence actually caused harm. Let’s say that Dr. X clipped your fingernails instead of your toenails – that would have been negligent, but your case against him isn’t going anywhere because you weren’t actually harmed by the negligence. On the other hand, if Dr. X unnecessarily amputated your finger or your hand then you definitely do have a valid legal complaint.

 

 

Variation by States:

Malpractice laws vary from state-to-state. Let’s use California as an example of some of the common caveats. One common difference between the states is variations in the statute-of-limitations. The statute-of-limitations is the time period during which you must file your complaint. For example, if the statute-of-limitations is five years and you file your suit twenty years after the fact you don’t have a case! In California, “a medical malpractice action for injury or death must be brought within one year from the date the claimant discovered the negligent act, but no more than three years from the date of the injury.” In other words, if a doctor is negligent and you are injured by this negligence then you only have a maximum of three years in California to file your malpractice complaint.

 

Caps on non-economic damages are another significant variation between the states. Non-economic damages are “compensation for pain, suffering, inconvenience, physical impairment, disfigurement, and other non-pecuniary injury.” Let’s assume that Dr. X amputated your hand and that you’re suing him. You can (and will) sue him for economic damages, in other words, your lost wages from your inability to work due to not having one of your hands anymore. However, the real money pot in most malpractice cases is from the non-economic damages, compensation from the emotional pain caused by walking around with a hook instead of your hand anymore. Some states cap these non-economic damages whereas others do not. In California, a state that has had malpractice reform, non-economic damages are limited to $250,000. In California this is also the cap for wrongful death, a good thing for doctors but a lousy deal for patients who have truly had their life screwed up due to medical negligence. It is true that malpractice suits have run wild in this country and hurt both physicians and the public due to burgeoning medical costs; however, it is also true that medical negligence really does hurt a substantial number of people and that blanket caps on damages can make it difficult for these people to win fair compensation, compensation that some of them need to pay for the medical care (not to mention rent, groceries, etc.) that they will need for the rest of their lives. As with most things in life, malpractice reform is a double-edged sword.

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis. Amazon Link to Doc’s Writing:  http://www.amazon.com/Leonardo-Noto/e/B00ATVOMCW/ref=ntt_dp_epwbk_0

NOTE: The Life of a Colonial Fugitive — my dark historical thriller — is free for your ereader at http://www.smashwords.com/books/view/215272. Thanks for reading!

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 16-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.com is intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!

The opinions voiced on this medical blog are solely the author’s own and they do not reflect the opinions or values of Dr. Noto’s employers, past or present. Dr. Noto’s medical blogs should never be used as supporting evidence for legal testimony — this is of course obvious to anyone who isn’t a complete moron, but some people are rather stupid.

References:

1.       Cheeks, Demetrius. 10 Things You Want To Know About Medical Malpractice. http://www.forbes.com/sites/learnvest/2013/05/16/10-thing-you-want-to-know-about-medical-malpractice/

2.       Legal Principles in Medicine. http://www.emedicinehealth.com/patient_rights/page8_em.htm

3.       Summary of Malpractice Laws by the State. http://www.mcandl.com/california.html

4.       Ending the Confusion: Economic, Non-Economic, and Punitive Damages. http://protectpatientsnow.org/sites/default/files/HCLA-Fact-Sheet-Ending-the-Confusion-Final.pdf

5. Lil’ Grim Reaper: d3v1ou5.deviantart.com

6. Blood Letting: https://www.google.com/search?as_st=y&tbm=isch&hl=en&as_q=medical+negligence+deaths&as_epq=&as_oq=&as_eq=&cr=&as_sitesearch=&safe=images&tbs=sur:fmc#as_st=y&hl=en&q=blood+letting&tbm=isch&tbs=sur:fc&facrc=_&imgdii=YsR2bBcHh5iFNM%3A%3Bky3e0zcsDCx3_M%3BYsR2bBcHh5iFNM%3A&imgrc=YsR2bBcHh5iFNM%3A%3BiNDlfOv6brzp6M%3Bhttp%253A%252F%252Fupload.wikimedia.org%252Fwikipedia%252Fcommons%252Fb%252Fbc%252FBloodlettingPhoto.jpg%3Bhttp%253A%252F%252Fen.wikipedia.org%252Fwiki%252FBloodletting%3B420%3B687

7. Quack Doctor: www.flickr.com

8. Breech Birth: http://en.wikipedia.org/wiki/Breech_birth

9. Captain Hook: cheese-rules1.deviantart.com