July 22, 2011

Collateral Damage

Sticks and Stones

by Corey Dawkins and Ben Lindbergh

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Stephen Drew, ARI (Right ankle surgery) [AGL: 65, ATD: TBD] (Explanation)
On Wednesday night, Drew's season quickly came to an end after he slid awkwardly and sustained a fracture of his right ankle/lower leg that required surgery to stabilize. In the video, as he goes into his slide, his cleats bite into the ground and force his ankle/foot into eversion as they become trapped under his left leg. Continuing to slide, the force became too great, causing the bones to snap and ending his season. Near the end of the play, you can see that the foot is turned in an unnatural position, almost completely opposite what is normal.

Even though initially the injury was thought to be from contact with the catcher's shin guards, the video clearly shows that the injury process was already in motion, as the ligaments are being sprained prior to contact. It was the continued rotational force between the ground and the body—not the compressive force of the shin guard—that caused the fracture.

Drew's surgery will include a plate and three screws, obviously knocking him out for the rest of the year. In the long term it should not affect his offensive production significantly, but his range in the field may be affected for a time. Often in these cases, short quick bursts of speed take time to return to pre-surgical levels, even absent complications similar to those seen in Kendrys Morales. Sometimes, the quick bursts never come back, and the player is not as quick and agile as before.

Grady Sizemore, CLE (Sports Hhernia surgery) [AGL: 46, ATD: +.046]
In a surprising move, it was announced that Sizemore had surgery on a sports hernia and not on his knee. Sizemore let on that his hernia had been bothering him since a slide in May, and this is his second time undergoing sports hernia surgery in the last three years. In 2009, he suffered a sports hernia in spring training, but he labored through the season until undergoing surgery in September.

Sports hernias simply aren’t something that most people can play with for long before the pain becomes too intense and needs to become addressed. The ATD above suggests that performance suffers during the period before the move to the disabled list and improves after the problem has been addressed. Sizemore's hernia will keep him out for the next six to eight weeks, which will give both his abdomen and knee a chance to heal.

Carlos Gomez, MIL (Fractured left clavicle) [AGL: 55, ATD: +.040]
Gomez made a nice diving catch, but it will cost him several weeks with a broken left clavicle. The clavicle can be fractured from a direct hit—from an elbow or a baseball—or by falling on the edge of the shoulder as Gomez did. The clavicle serves as a rigid support for the entire shoulder girdle while also protecting vital neurovascular structures in the neck and upper shoulder. Despite the fact that Ryan Braun actually heard Gomez’s bone snap from his position in left field, fractured clavicles usually do not require surgery. As with many other types of fractures, as long as there is not significant displacement or angulation, this one usually heals well with some immobilization. Even without surgery, though, Gomez will likely miss at least six to eight weeks to let the bone heal.

Carlos Gonzalez, COL (Right wrist inflammation) [AGL: 3 (21DL), ATD: +.023(+.010DL)]
In the video, Gonzalez is clearly in more pain than normal inflammation would cause in the acute setting. When the athletic trainers begin to examine the wrist, you can see that Gonzalez is holding the outside of it, and that is where all the medical attention is being paid, in part to an interesting structure called the triangular fribrocartilage complex, or TFCC, for short.

This complex is mainly composed of a disc and several ligaments that keep it in place. It is only 5 mm thick, but it is the main stabilizer to the distal radioulnar ulnar joint on that side of the wrist and permits most motions of the wrist to occur. Injuries to this structure can be difficult to identify, and they’re commonly misdiagnosed as recurrent simple sprains that end up requiring surgery. They can be difficult to pick up on MRI, leading to further imaging after the wrist continues to cause problems.

After leaving the game on Thursday with a painful right wrist, Gonzalez went straight for an MRI to try to tease out the cause for the continued pain. The initial diagnosis of inflammation of the ligaments is not very specific, but it could include an injury to the TFCC. It's becoming obvious that Gonzalez needs more than a few days here and there to resolve the issue fully, so even if the TFCC is not injured, there is a chance that he will end up on the disabled list.

Orlando Hudson, SDN (Unconsciousness) [AGL: TBD, ATD: +.TBD]
Not all episodes of unconsciousness are associated with concussions, and that’s one of the reasons why the new concussion protocols are important to players’ health. Hudson crashed into the wall and remained motionless for several minutes, but the worst fears started to subside once he was seen moving his arms. After the game, he was alert in the locker room, but a battery of tests (including an ImPACT test) still needs to be performed per protocol. There have been no episodes of non-concussed unconsciousness in the database, hence the TBD for AGL and ATD.

Flesh Wounds: Fernando Rodney should be activated in the next few days from a strained back... Brandon Kintzler will have the surgery for the stress fracture in his elbow, ending his season... Brad Thomas has been shut down from throwing for the next four weeks, since his elbow continues to be inflamed from a small spur... Kyle Lohse is having a “finger issue” examined, according to Tony La Russa, which could mean anything from a tendon injury to a circulatory issue. More details to come... Jordan Schafer was scratched yesterday because of a left middle finger sprain after sliding headfirst on Wednesday... Jason Bay is day-to-day with a tight right hamstring.

Corey Dawkins is an author of Baseball Prospectus. Follow @CoreyDawkinsBP
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Ben Lindbergh is an author of Baseball Prospectus. Follow @benlindbergh
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