We know Derek Stepan broke his fibula, but outside of that, we don't really know all too much. While there are plenty of "practicing doctors" here at the Banter, it's always good to get an actually informed opinion, so we did that.
Last week, I got a chance to chat with Dr. Alexis Colvin of the Icahn School of Medicine at Mount Sinai. Dr. Colvin is Dr. Colvin is a board certified orthopaedic surgeon and member of the American Academy of Orthopaedic Surgeons, The American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America and International Society for Hip Arthroscopy. Below is my conversation with her. Questions are in bold, and the answers are italicized. A big thanks to Dr. Colvin and her office for taking the time to chat.
What exactly does the fibula do, and how does breaking it inhibit things that a hockey player does frequently, like skating, and changing directions?
The fibula actually—there's two bones: the fibula and the tibia—and the fibula is the smaller of it. It actually doesn't bear that much weight, the bone itself. The reason it's important is actually to the actual functioning of the ankle itself. Providing stability for the ankle. A lot of the ligaments that you sprain when you have an ankle sprain are actually attaching to the bone, and there are also a lot of muscles that attach around that area as well.
Could a previously ankle injury lead to a fibula break?
It depends what it was. If the fibula had been broken before, it's possible. But like an ankle sprain or something like wouldn't necessarily lead to a fibula fracture.
What is the general recovery time for that kind of injury? And does that timeframe mean someone is off his feet for that long, or able to return to full activity by the end of that stretch?
For a broken bone to heal it generally takes about six weeks. A lot of it depends on how severe the break was. But usually it's about six weeks, and then obviously, no, you're not going back to pro sports right away. It's pretty progressive to sports. So you're going to start with lower impact stuff first, and then gradually move on to higher impact. So I would say overall it may take two months for him to return completely to the level he was at before.
What are the difficulties one faces in recovering from a broken fibula?
Potentially coming back too early and there's still pain. It could prolong the recovery. More than anything else it's probably frustrating because he was playing at such a high level, and he can't go back to that right away.
Last year, Steven Stamkos missed pretty significant time with a broken tibia. With a non-contact break, is one at risk of breaking a tibia considering how the break occurred? Did Stepan dodge a bullet by not breaking his tibia?
Usually when you're talking about the injury, you usually injure both at the same time, but one doesn't lead to the other. They're unrelated. It really just depends on the force. The tibia is the bigger of the two bones, so in general, if you're going to have a severe amount of force to the leg, you're going to injure the tibia; either one or both. It's really the force, and then also where the force is applied. If someone had an injury on the inner part of your leg-if you look down at your leg, the bone on the inner part of it where your ankle sticks out, that's the bottom part of the tibia. If the force comes from that side, you could injure your tibia if the force is strong enough.
Are non-contact breaks of the fibula common? Does their likelihood increase if there was prior trauma to the area?
It can be a rotational injury, so it doesn't have to occur from contact.
Not necessarily. Essentially, they're calling it a fibula fracture. I don't know where it was. It really just depends on where it was on the bone.
I know he had an ankle contusion before.
The fibula is a long bone, so part of it is up by the knee, and part of it is down by the ankle, so it really depends on where [the break] actually is.
Is surgery ever an option for fibula breaks?
Yeah, of course, it just depends on where it is. In general with the more severe breaks, if it's down by the ankle, it's actually considered an ankle fracture, in which there are certain cases we'd recommend surgery.
What's the timetable for a recovery from fibula surgery?
It all depends on how severe it is. In general it's about the same thing, probably six weeks for the bone to heal. So you might say, ‘why don't we just do surgery now?' and with the six weeks, it's just how long it takes to heal. And that bone is either going to heal with casting and without surgery, or if someone looks at the films that there's no way it's going to heal without surgery, that's when they recommend. Not if he would heal within that six-week time period without surgery.