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/

The Medical Physiology of Brazilian Jiu Jitsu Submissions

I’m in the mood to have a little bit of fun for the weekend, and fun to me means either spending time with my dog or spending some time on the jiu jitsu mats! For the uninitiated, Brazilian jiu jitsu is an advanced form of Japanese jiu jitsu that was developed by the Gracie family in Brazil during the early 20th century, especially by Helio and Carlos Gracie. Helio was a 140lb little guy who routinely fought in no holds barred, full contact fights in Brazil against opponents who usually were twice his size, winning every fight during his long career save one. Helio’s son later went on to become the Champion of the first 4 Ultimate Fighting Championships (UFC) in spite of the fact that he only weighed 175lbs and that many of his opponents topped the scales in the high 200s, the 300s, and even the 400lb range! Brazilian jiu jitsu is essentially the art of using chokes and joint locks to enable a smaller person to defend themselves against a much larger opponent—here’s how it works. Before I explain this stuff, you obviously should not try any of this at home, or anywhere else for that matter, without the supervision of someone who knows what the heck they are doing (e.g. a Brazilian jiu jitsu instructor)—many of these techniques are potentially fatal if not performed by a skilled practitioner.

The most famous chokes in Brazilian jiu jitsu are the rear naked choke and the triangle choke. The rear naked choke is performed by getting behind your opponent and wrapping your arm around their neck so that their trachea (windpipe) rests in the crook of your elbow. Using your other arm as a brace and as a fulcrum, the choking arm is then closed around your opponents neck, using the forearm and the biceps to squeeze both sides of the neck, resulting in the rapid unconsciousness (and if not quickly released, death) of your opponent. This choke is a “blood choke” and it works by compressing the carotid artery that is located on either side of the neck. The carotid artery is responsible for ~80% of blood flow to the brain and, because the brain has an extremely high metabolism (metabolism shuts down without oxygen, which is carried in blood), it calls it quits after 10-15 seconds of choking and unconsciousness is the result. A brain that is deprived of blood for greater than about 4 minutes suffers irreparable damage so this choke is rapidly let go in a training environment—in a street fight it is deadly, and easily so. The triangle choke is performed similarly but instead of squeezing both sides of the opponents neck with your arm the jiu jitsu practitioner instead use their leg to squeeze one side and their opponents trapped arm to squeeze the other side. This technique is performed from your back (your “guard”) and, although difficult to learn initially, is easily performed by a trained practitioner of jiu jitsu and it is one of the most common submissions in competitive mixed martial arts.

The other form of choke is the “air choke,” a choke that is performed by directly crushing the windpipe. Unlike the blood choke, which can be safely performed in training by people who know what they’re doing, the air choke is very likely to cause severe damage to the trachea which may necessitate a trip to the emergency room or the morgue. The simplest way air choke is performed by ramming the outer bone of the forearm, the ulna, down onto your opponents neck—this technique is primarily used in extreme self-defense or combat situations and, if I haven’t said it enough, should not be tried at home!

Joint locks are probably the most common form of submission by grapplers in both grappling competitions and in mixed martial arts fights. Joint locks, like arm bars and knee bars, are obviously painful but they are also potentially fatal for reasons that aren’t quite as obvious. The knee bar is the best example, as I’ll explain, but this holds true for the arm bar as well. A knee bar is performed by wrapping yourself around that front of your opponent’s leg and then forcibly straightening the knee joint until it is locked. Pressure is then applied to the joint to straighten it farther than it is naturally supposed to go, resulting in pain. Now it doesn’t take a genius to figure out that you could break someone’s leg this way, and since a proper knee bar places all of your body weight on top of the person’s leg it also is fairly evident that this isn’t a very difficult thing to do if you really needed to to defend yourself. However, what isn’t so obvious is that a huge artery, the popliteal artery that supplies your lower leg, lies directly behind the knee joint and if the knee joint is broken the popliteal artery is likely to rip as well, leading to massive blood loss. Arm bars are similar because the brachial artery, which also is fairly large, is located just over the elbow joint and an elbow that gets bent the wrong way (i.e. broken) can tear this artery to shreds. And one final time because there is no shortage of idiocy in the world—do not try any of these techniques at home!!! If you want to learn how to grapple for self defense, go join a jiu jitsu gym, which is also a great way to get into shape and to build self-confidence and self-esteem!

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis.

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in private practice. Dr. Noto is the author of four full-length works and he also writes for a medical education entity 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 11-month-old American bulldog who enjoys slobbering 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 is currently 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!). This blog is intended to present general medical information for entertainment purposes and not as a specific guideline 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. The internet and self-education are great, but they don’t replace your doc!