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Tuesday, June 22, 2010
Smith's value unaffected by arm fracture


It's déjà vu all over again for Carolina Panthers' star receiver Steve Smith.

Just days shy of being six months removed from surgery to stabilize a left forearm fracture sustained in Week 16 of the 2009 season, he suffered yet another break that required yet another operation to insert more hardware. Smith will miss at least the start of training camp while his left forearm heals -- again.

Darin Gantt of the Charlotte Observer is reporting that the broken bone in question is the radius, the same bone Smith fractured in December. The radius is one of the two bones of the forearm, and it runs from the elbow toward the thumb side of the wrist joint. The radius is commonly broken by falling on an outstretched arm (which is how Smith's agent, Derrick Fox, indicates this latest injury occurred) or by a direct blow, which is what happened to Smith in December when his forearm met squarely with the helmet of New York Giants' safety Michael Johnson after a 27-yard reception. (For what it's worth, Smith still hung onto the ball and scored a touchdown on that play with a "floppy" broken forearm, securing his tough-as-nails reputation).

Steve Smith
Steve Smith finished 18th among wide receivers in fantasy scoring last season.

Despite this being the second break in his forearm, there are some encouraging aspects to Smith's injury. Since the fracture is in the shaft (the long portion) of the bone and not at the wrist joint, he is not expected to have significant range of motion concerns for his wrist and hand. Fox stated that Smith suffered no nerve damage, another positive, meaning the function of his wrist and hand musculature, as well as his sensation in the area, remains intact.

The good news at this point is that Smith is expected to be ready for the season opener when the Panthers visit the New York Giants on Sept. 12. Fractures require roughly six weeks for full healing, assuming no complications. That translates to him returning the latter part of the first week of training camp. Even as the forearm heals, Smith should be able to undergo physical training and conditioning to maintain his cardiovascular fitness and lower-body strength. He will then have an additional six weeks until the season opener. Based on this timetable, Smith should have an opportunity to get some work in with his team and perhaps even some preseason competition before the season gets under way.

Will there be any concerns about the risk for that forearm going forward? It's safe to say, given the fact this bone has been broken twice within six months, there could be concern the arm might be vulnerable. After all, it's possible the first injury made the forearm slightly more susceptible to this break, although no one could have predicted that with any degree of certainty. Smith's initial injury required the insertion of a plate and screws to help stabilize the broken bone. The plate forms a bridge across the broken ends and essentially keeps them still while new bone forms to repair the break. But that hardware, while necessary to facilitate proper healing, can present a challenge of its own where it interfaces with the bone.

Although we often think of bone as hard and unyielding, it does have some capacity to accommodate bending and torsion or twisting forces. Steel plates, however, might alter how forces are absorbed. When a bone with implanted hardware is subject to bending or twisting, which might occur with a fall on an outstretched arm, instead of being evenly dispersed across the bone, those forces can concentrate at the bone-hardware interface, typically a weak point, and lead to re-injury.

In a paper presented at the 1989 American Academy of Orthopedic Surgeons Meeting, a 10-year review of NFL players who had undergone surgical stabilization of forearm fractures with plates and screws revealed a 17 percent re-fracture rate following return to play. That translates to nearly one in five players who end up re-injuring the area despite uneventful, uncomplicated surgery and rehab. Recent examples include safety Roy Williams, who first fractured his forearm while with the Dallas Cowboys in 2008 then re-injured it in 2009 with the Cincinnati Bengals, and Buffalo Bills linebacker Paul Posluszny, who fractured his forearm as a rookie in 2007 and again in 2009. So why not just take the plates and screws out? That's a discussion that is ongoing in the medical community. Unfortunately, removal of hardware leaves holes in the bone, specifically where screws were implanted. Those holes are weak spots in the bone where re-fracturing can also occur, perhaps at an even higher rate than with the hardware in place. The best safeguard against re-injury following screw removal is extended downtime, not necessarily a desirable alternative for a high-level athlete. As it stands, leaving the hardware in place is the most common practice.

Smith's ability to perform at a high level this fall should not be affected presuming his forearm fully heals by the start of the season. Unlike some soft-tissue injuries that might limit a player's speed or agility and consequently affect overall performance, once the bone has healed, Smith should suffer no lingering effects. While it's possible he could re-injure the arm with a fall or a direct blow, it's also possible he could continue without incident.

In Carolina, the issue of who will throw Smith the ball on Sundays or who will line up opposite him at the receiver position might be of bigger concern than his health. While fantasy owners should monitor Smith's progress as their draft day approaches, they should expect him to be ready to open this NFL season against the very team that ended his last one.