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Matthews' thumb surgery necessary in long run

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Tom Silverstein, Milwaukee Journal Sentinel
October 13, 2013

GREEN BAY—In the history of the NFL, there are probably hundreds of players who have taped, splinted or casted a broken thumb and returned to their position with little or no lost playing time.

If Green Bay Packers linebacker Clay Matthews were to try to play with the broken right thumb he suffered against the Detroit Lions last week—even after having surgery Monday to stabilize the fracture—the odds of him permanently losing grip strength would be relatively high.

Three orthopedic surgeons who specialize in hand injuries all said that the type of break Matthews suffered—known as a Bennett's fracture—requires immediate immobilization and the prospects for long-term damage are high if the bones don't heal exactly right.

“The reason to get it to heal right is for 10, 15 years down the road so the person has a functional thumb that isn't in a painful arthritic state,” said Barry Callahan, an orthopedic hand specialist at the James Andrews Institute. “To be able to pinch buttons and put your pants on, snaps, you name it.

“You don't really miss your thumb until it's in a cast or something like that. You find out pretty quick when you're asking your wife to button your shirt right.”

A source confirmed a report from Matthews' occasional workout partner, Fox Sports' Jay Glazer, that the linebacker had suffered a Bennett's fracture. Surgery was performed Monday night at an undisclosed location and Matthews will miss around three to four weeks, according to coach Mike McCarthy.

A Bennett's fracture, named after Irish surgeon Edward Hallaran Bennett, who first described it in 1882, is an injury that occurs at the base of the thumb where the first metacarpal bone attaches to the hand. The bone breaks away from the joint, leaving behind a fragment that remains attached to one of the ligaments forming the thumb joint.

Outside of sports, the injury is often found among people who have hit someone or something with their fist, creating tremendous force down the shaft of the thumb and into the joint. In Matthews' case, the injury occurred during a sack of Lions quarterback Matthew Stafford, either as he swatted his right hand on the takedown or at the end of the play when he landed on the ground.

“It's a very painful injury,” Callahan said. “It's not really that you couldn't play with it, but it's one of the things where you aren't going to play very well. You're not going to want to shove your hand in there. You're not going to be aggressive with it.”

According to Richard A. Berger, a professor of hand surgery and chair of the division of hand surgery at the Mayo Clinic, the most critical part of the repair is making sure a smooth surface exists when the first metacarpal is reattached to the remaining fragment.

If the two pieces aren't perfectly aligned, the prospects for arthritis occurring in the joint are great.

“We want that (fracture) to be anatomically reduced as much as possible with the hope that will allow it to heal,” Berger said. “If these are too far apart from one another, the bone surfaces won't be in contact with each other properly and it may not heal. We call that a non-union.

“And the other thing, we want it to heal so that the bone is positioned correctly and not rotated in a funny direction, but also to preserve the joint surface that it doesn't get worn away because there's a big step off in there.”

The surgery generally consists of a plate, screws or pins drilled into the first metacarpal and the fragment to form the union of the two pieces. Glazer reported that pins were used in the surgery Matthews had.

These pins, also known as “K-wire”, are drilled through the skin and into the two pieces of bone so they are held together in proper union. Typically, the wires stick out of the skin until the bone is healed and then removed.

With some hand and finger fractures, a cast can be worn and a soft padded club can be worn over it so a player can continue playing. Several Packers have played with clubs in recent years, including safety Morgan Burnett, end Cullen Jenkins and linebacker Brandon Chillar.

In Matthews' case, however, none of the doctors recommend playing with a club because the chances of the two bones moving—even with the pins in place—is too great.

“What you worry about is pulling the hardware out of the bone fragments in the end, which is sort of a morselized mess,” Callahan said. “It's a tightrope for these guys. They'd rather be playing, but they have to factor in what the long-term downside is in trying to go too soon.”

In describing Matthews the day he drafted him in 2009, general manager Ted Thompson marveled at the strength and quickness of his hands. “He's got the ability to extend his hands and leverage against offensive linemen and stay on his feet in positions where most people wouldn't be able to stay on their feet,” Thompson said.

Thus, the prospect of Matthews losing some or all of the grip in his dominant hand made the Packers' decision to sit him down for about a month all the more logical. On the sack on which he brought down Stafford, Matthews used his powerful right arm to trip the quarterback and bring him down.

The main reason a cast wouldn't work in protecting Matthews were he to play right away is that it would not adequately protect him from the force that the hand would be subject to in live action.

“There's a risk of displacing it,” said Peter Evans, director of the Orthopedic Upper Extremity Center at the Cleveland Clinic. “A cast doesn't hold it completely. A cast is a centimeter away from the fracture and if the muscles contract they can cause it to displace.”

Even if the pins were strong enough to hold the thumb together, Berger said he would have reservations about someone playing with a club on because the potential for infection would exist with sweat seeping in where the pins are located.

For the present, Berger said it's key to keep the thumb immobilized and sometimes the forefinger so there are no muscles pulling on the thumb joint. In most cases, a plaster cast is used, but it's not known with Matthews whether the surgeon used a cast or some other device to stabilize the joint.

Evans said that if the joint is displaced again, it's likely the surgeon would have to operate on the hand through an incision and “the more invasive you are, the more complications you might have.”

As for the length of time an athlete would be sidelined with a Bennett's fracture, all said it would depend on the severity of the fracture, the patient's recuperative powers and the doctor's comfort with the amount of healing that has taken place.

All three said the recovery time is usually six weeks, but since they have no direct knowledge of Matthews' injury, they couldn't predict when he would be cleared to play. McCarthy said he was told Matthews could return in as soon as three weeks, but ultimately it will be team physician Patrick McKenzie's decision.

When he returns, Matthews will have to wear a cast or brace on his hand.

“We're all nervous about these things healing as it is,” Berger said. “There's all these variables that are going to affect your risk assessment with the player. The player is going to be champing at the bit to get back out there and so is everybody else associated with that player.

“It will be the team doc or whoever takes care of this person that is going to be nervous about this because we often just don't know how strong the repair is until it's healed. Once it's healed, it's going to be as strong as the original equipment. The best people to work through that are the patient and the person who is taking care of him.”



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