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Leg Injury an Unfortunate Product of Physics

For 10 excruciating minutes, the national feel-good celebration that is March Madness was halted in its sneakers. Millions watching two college basketball powers recoiled from yet another sports injury, one so horrific that CBS almost immediately stopped showing the replay.

Yesterday, University of Louisville guard Kevin Ware was shown on Twitter standing with the aid of crutches after surgery on his broken leg. His injury joined the short list of the most gruesome plays in televised sports history, a fluke of physics all the more bizarre because it did not occur on a football field, where we have come to expect the carnage of violent collisions.

Ware did not touch a soul. He simply landed awkwardly in front of his team’s bench after trying, and failing, to block a 3-point shot by Duke’s Tyler Thornton, snapping the tibia and fibula of his right leg. One broken bone stuck through Ware’s skin.

“It’s a torsional injury,” said Craig Bennett, head orthopedic surgeon for University of Maryland athletics, who has seen only two similar injuries in the past decade. “It’s a rotational injury, and all the stress gets concentrated on one area.”

Normally, he said, knee or ankle ligaments would have absorbed the stress of Ware’s twisting leap, tearing if the forces were too great, or doing their job and sending him back to the court. But Ware landed in just the wrong way, Bennett believes. The result was an injury that is likely to be remembered as long as the NCAA tournament is played.

Another, less likely possibility, said Frederick Azar, an orthopedic surgeon and spokesman for the American Academy of Orthopedic Surgeons, is that Ware had a weak spot in the bone, possibly from an undiagnosed stress fracture. Such fractures can result from the constant pounding on a basketball player’s legs. More rarely, a cyst or benign tumor can create a weakness. But only his doctors would know, Azar said.

Ware’s injury raised memories of the 1985 play that ended the career of Washington Redskins quarterback Joe Theismann. Theismann’s right tibia and fibula were broken when he was hit by New York Giants linebackers Lawrence Taylor and Harry Carson as a national audience watching Monday Night Football looked on in horror. Younger Redskins fans may have been reminded of the unnatural angle of Robert Griffin III’s lower right leg as he crumpled to the ground with torn knee ligaments in January’s playoff loss to the Seattle Seahawks.

Ware’s injury may be closer to the one sustained in 1989 by Cincinnati Bengals lineman Tim Krumrie, who broke his tibia in two places and his fibula in another when he landed awkwardly while trying to make a tackle during Super Bowl XXIII.

Krumrie not only refused to go to the hospital, he watched the game from the locker room until paramedics warned that he could go into shock. He was back for the start of the next season and continued his streak of consecutive games played.

Doctors operated on Ware for about two hours Sunday night, the University of Louisville said, setting the bone, inserting a rod made of titanium or stainless steel in Ware’s tibia, and closing the wound in his skin. The 36- to 40-centimeter-long rod (14 to 15 inches) will probably remain in his leg unless it or the screws that hold it in place cause him pain, Azar said.

When a bone breaks the skin and is exposed to the air — an “open fracture” — infection is a significant concern, and doctors must watch for it closely, experts said yesterday. Other possible complications include the bone failing to knit together and damage to nerves and blood vessels.

But barring such developments, Azar said, estimates that Ware could need a year to recover may be exaggerated. Azar said the basketball player could return in as little as six months.

“If the condition of the nerves and the blood vessels are fine, he’ll do well,” Bennett said. He predicted that within 18 months, Ware could be playing as well as he had before the injury.

Craig Roberts, an orthopedic surgeon at the University of Louisville’s medical school, said in a written statement that Ware could be back by the end of next season. “The outcome of compound fractures … of the tibia have come a long way from the days when they were universally fatal from bleeding or gangrene, or meant an immediate loss of limb,” he said.

Former Louisville running back Michael Bush sustained a similar lower-leg injury in 2006 during his senior year and has had a productive professional career since. Maryland defensive back Nolan Carroll went down with a non-contact bone break in 2009 before playing for the Miami Dolphins.

“We fixed him that night, and he played” for the Dolphins the following year, Bennett said.

In a teleconference yesterday, Louisville basketball coach Rick Pitino, who had wiped away tears as medical personnel tended to Ware on the court, said his player was “in great spirits” after surgery.

“I know right before the surgery he was able to watch the players at the press conference, and the nurses and the doctors told me that was the first time he just broke down and cried, when the players were talking about him,” Pitino said.

Ware’s mother, Lisa, flew in from Georgia, where she had watched her son’s game and his injury Sunday. “She’d been crying all night,” Pitino said. “Once she gave him a hug this morning, everything was fine.”

If all goes well, Ware could return to Louisville today.

Theismann and Bush tweeted their sympathies, and Bush spoke by phone with Ware before acknowledging publicly that he wept at the sight of Ware crumpling.

“Sometimes, you have an event that makes people realize that there’s something more important than the tribe, than the colors we wear,” said Eric Simons, author of the book The Secret Lives of Sports Fans, out Thursday. “The story of sports fans that is really underappreciated is that we do shut off our red colors and our blue colors” and empathize as human beings.

Adding to the shock was the scene of the injury — a basketball court rather than a football field or a boxing ring, Simons said. Reactions to events in sports are very “context-dependent,” he said, something that helps explain why violence among fans is more common at soccer matches, where some almost expect it, than at baseball games.

“I don’t think you need much of a psychological explanation” for the reaction to Ware’s injury, Simons said. But “any time you’re not primed for it, if you’re not expecting this from the context of the event, it does come as a shock to your brain, at a very deep level.”