As a reconstructive foot surgeon with major lower extremity trauma experience, something just doesn't quite add up with Derek Jeter's ankle fracture. Most people watching the unextraordinary play, were shocked to see that he couldn't get up -- let alone have a fractured ankle. So, why did the Yankee captains ankle break?
I suspect Jeter had an underlying stress fracture (not bone bruise) that weakened his ankle, and I'm going to tell you why.
It's no secret that Jeter has been nursing a sore ankle, which has been described as a bone bruise, from an injury in September. Bone bruise can mean a lot of things, but in most basic terms the bone is irritated. A more severe bone bruise would be termed a stress fracture. A stress fracture can be considered as a pre-fracture or a microscopic fracture (not seen on standard x-ray).
In Jeter's case, he sustained an ankle fracture from what appeared to be a routine maneuver. To me, this suggests his ankle bone was likely weakened, pre-disposing it to injury. Granted there is nothing simple about any play made by a professional athlete, and a lot of skill and body training goes into each move. It is indeed possible that Jeter just twisted the ankle in such a way, with the proper amount of force, that caused the break. Nobody will argue that as a real possibility.
But, ankle fractures break in reliable consistent patterns from four mechanisms, depending on the foot position to the leg, rotary force and the amount of energy determines the severity. The most common ankle fractures involve the outer leg bone (the fibula) as a simple break. When more energy and rotation is present the inside of the ankle (the tibia) could break too.
Jeter's dive does not demonstrate the typical mechanism for significant injury, which is why he could have had an underlying stress fracture. It was clear Jeter had a bone bruise. However, bone bruise can advance onto stress fracture, and then onto full through and through fracture.
The best analogy, I use in my practice to explain stress fractures, is to compare a bone to the old yellow No. 2 pencils -- the ones with the yellow paint. If one grabs the pencil at opposite ends, and tries to bend the pencil, by bowing it, there will be increased stress on the center of the pencil -- that is a bone bruise. With more force applied, the paint on the pencil (opposite the force) will start to chip/crack, but the pencil is still intact -- that is a stress fracture. When the pencil breaks from force - that is a fracture.
Back to Jeter's fractured ankle. His ankle is fractured based on the x-ray. Most decisions to surgically repair ankles are made on simple x-rays. He has since had a full workup with MRI and CT, which are helpful to tell the full story.
If Jeter did have an underlying stress fracture, then his fracture pattern could be more unconventional. That could have implications should he need surgery. At this time we don't know exactly what type of ankle fracture Jeter has and the extent of the injury. Fortunately for Jeter, with or without surgery, ankle fractures tend to rehab just great.
Should it turn out that Jeter did have a stress fracture, teams are going to reconsider just how they manage players with 'bone bruises.'
--Dr. Blitz
New York City
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