Tim Hudson's unfortunate injury

Sydney K Yau, DPM.  Follow me on Twitter @sydneyyau

Atlanta Braves pitcher Tim Hudson sustained an ankle fracture last night while covering 1st base.  The runner, Eric Young Jr. of the New York Mets, inadvertently stepped on Hudson's lower leg trying to get to 1st base ahead of the throw.  Hudson was immediately in pain and fell to the ground.  See the injury here:

Hudson is to undergo surgery when the swelling subsides.

Explaining the injury

Looking at the replay, you can tell that Young Jr. lands on Hudson's lower leg and causes the lower leg to flatten and turn out.  Hudson likely has a tibia and fibula fracture above the ankle joint and possibly a syndesmotic injury.  The tibia and fibula are the leg bones of the body.  Together they connect the knee to the ankle and form the ankle joint.  They are held together near the ankle by a strong ligament called the syndesmotic ligament or interosseous membrane.  This ligament provides stability to the ankle and is important for many athletes.  Occasionally this ligament is sprained and is diagnosed as a "high ankle sprain".

This fracture is a result of direct impact so it does not follow any typical fracture patterns from ankle fractures sustained from indirect impact such as from twisting injuries.  Looking at the replay, it appears that Young Jr. lands above the ankle joint at the lower leg.  This is important as it does not appear that the fracture affects the ankle joint itself.  If the fracture was within the ankle joint, he is at risk for arthritis in the joint and this may delay his healing and affect his rehabilitation.  If the fracture, as I suspect, is above the ankle joint, the tibia and fibula can be realigned with surgery and there is less risk of arthritis in his joint.  If there is separation of the tibia and fibula on radiographs, this means that the syndesmosis is torn and needs to be repaired as well.

Fixing the injury

Surgery is needed to realign the tibia and fibula and possibly repair the syndesmotic ligament as well. The fracture will likely be reduced surgically and held together using plates and screws.  If the syndesmotic ligament is torn, screws are often placed across the ligament to repair the ligament.  The surgeon should check the alignment of the bones in all three planes and make sure the ankle joint is in anatomic position to reduce risk of arthritis in the future.  This is especially important should the fracture extend into the ankle joint.  The surgeon should also check to make sure adequate length is maintained of the bone to prevent shortening, causing a limb length discrepancy.  This is more of a risk if the fracture is in multiple pieces, which may be possible in this case.

Hudson's prognosis

I believe that Hudson is likely done for the season.  Recovery time for the bones to heal often will last 6 to 8 weeks.  After the bones heal, Hudson will need to rehab his ankle for at least a month or two to restrengthen his leg and redevelop stability in his ankle should the syndesmotic ligament be torn.  The biggest risk after surgery is arthritis in the ankle and instability of the ankle.  This can happen if the ankle is not well aligned after surgery.  Due to the healing times, I believe he will likely be unable to start pitching until after the current season ends.  However, as long as the fracture is reduced back into its correct anatomic position and bone is allowed to heal, I believe this shouldn't be a career ending injury for Hudson and he should be back pitching next season for the Atlanta Braves unless he chooses to retire.